[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: 42CFR489.23]



[Page 949-950]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 489_PROVIDER AGREEMENTS AND SUPPLIER APPROVAL--Table of Contents

 

               Subpart B_Essentials of Provider Agreements

 

Sec.  489.23  Specific limitation on charges for services provided to 



certain enrollees of fee-for-service FEHB plans.



    A provider that furnishes inpatient hospital services to a retired 

Federal worker age 65 or older who is enrolled in a fee-for-service FEHB 

plan and who is not covered under Medicare Part A, must accept, as 

payment in full, an amount that approximates as closely as possible the 

Medicare inpatient hospital prospective payment system (PPS) rate 

established under part 412. The payment to the provider is composed of a 

payment from the FEHB plan and a payment from the enrollee. This 

combined payment approximates



[[Page 950]]



the Medicare PPS rate. The payment from the FEHB plan approximates, as 

closely as possible, the Medicare PPS rate minus any applicable enrollee 

deductible, coinsurance, or copayment amount. The payment from the 

enrollee is equal to the applicable deductible, coinsurance, or 

copayment amount.



[62 FR 56111, Oct. 29, 1997]