[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR1002.211]



[Page 1170-1171]

 

                         TITLE 42--PUBLIC HEALTH

 

      GENERAL--HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

PART 1002_PROGRAM INTEGRITY_STATE-INITIATED EXCLUSIONS FROM MEDICAID--

 

                     Subpart C_Permissive Exclusions

 

Sec.  1002.211  Effect of exclusion.



    (a) Denial of payment. Except as provided for in Sec.  

1001.1901(c)(3), (c)(4) and (c)(5)(i) of this chapter, no payment may be 

made by the State agency for any item or service furnished on or after 

the effective date specified in the notice by an excluded individual or 

entity, or at the medical direction or on the prescription of a 

physician who is excluded when a person furnishing such item or service 

knew, or had reason to know, of the exclusion.

    (b) Denial of FFP. FFP is not available where the State agency is 

required to deny payment under paragraph (a) of this section. FFP will 

be reinstated at such time as the excluded individual



[[Page 1171]]



or entity is reinstated in the Medicaid program.



[57 FR 3343, Jan. 29, 1992, as amended at 63 FR 46691, Sept. 2, 1998]