Title 42

PART 489

Part 489 - Provider Agreements And Supplier Approval

PART 489 - PROVIDER AGREEMENTS AND SUPPLIER APPROVAL Authority:42 U.S.C. 1302, 1395i-3, 1395x, 1395aa(m), 1395cc, 1395ff, and 1395(hh). Source:45 FR 22937, Apr. 4, 1980, unless otherwise noted.

42:5.0.1.1.7.1SUBPART A
Subpart A - General Provisions
42:5.0.1.1.7.1.23.1SECTION 489.1
   489.1 Statutory basis.
42:5.0.1.1.7.1.23.2SECTION 489.2
   489.2 Scope of part.
42:5.0.1.1.7.1.23.3SECTION 489.3
   489.3 Definitions.
42:5.0.1.1.7.1.23.4SECTION 489.10
   489.10 Basic requirements.
42:5.0.1.1.7.1.23.5SECTION 489.11
   489.11 Acceptance of a provider as a participant.
42:5.0.1.1.7.1.23.6SECTION 489.12
   489.12 Decision to deny an agreement.
42:5.0.1.1.7.1.23.7SECTION 489.13
   489.13 Effective date of agreement or approval.
42:5.0.1.1.7.1.23.8SECTION 489.18
   489.18 Change of ownership or leasing: Effect on provider agreement.
42:5.0.1.1.7.2SUBPART B
Subpart B - Essentials of Provider Agreements
42:5.0.1.1.7.2.23.1SECTION 489.20
   489.20 Basic commitments.
42:5.0.1.1.7.2.23.2SECTION 489.21
   489.21 Specific limitations on charges.
42:5.0.1.1.7.2.23.3SECTION 489.22
   489.22 Special provisions applicable to prepayment requirements.
42:5.0.1.1.7.2.23.4SECTION 489.23
   489.23 Specific limitation on charges for services provided to certain enrollees of fee-for-service FEHB plans.
42:5.0.1.1.7.2.23.5SECTION 489.24
   489.24 Special responsibilities of Medicare hospitals in emergency cases.
42:5.0.1.1.7.2.23.6SECTION 489.25
   489.25 Special requirements concerning CHAMPUS and CHAMPVA programs.
42:5.0.1.1.7.2.23.7SECTION 489.26
   489.26 Special requirements concerning veterans.
42:5.0.1.1.7.2.23.8SECTION 489.27
   489.27 Beneficiary notice of discharge rights.
42:5.0.1.1.7.2.23.9SECTION 489.28
   489.28 Special capitalization requirements for HHAs.
42:5.0.1.1.7.2.23.10SECTION 489.29
   489.29 Special requirements concerning beneficiaries served by the Indian Health Service, Tribal health programs, and urban Indian organization health programs.
42:5.0.1.1.7.3SUBPART C
Subpart C - Allowable Charges
42:5.0.1.1.7.3.23.1SECTION 489.30
   489.30 Allowable charges: Deductibles and coinsurance.
42:5.0.1.1.7.3.23.2SECTION 489.31
   489.31 Allowable charges: Blood.
42:5.0.1.1.7.3.23.3SECTION 489.32
   489.32 Allowable charges: Noncovered and partially covered services.
42:5.0.1.1.7.3.23.4SECTION 489.34
   489.34 Allowable charges: Hospitals participating in State reimbursement control systems or demonstration projects.
42:5.0.1.1.7.3.23.5SECTION 489.35
   489.35 Notice to intermediary.
42:5.0.1.1.7.4SUBPART D
Subpart D - Handling of Incorrect Collections
42:5.0.1.1.7.4.23.1SECTION 489.40
   489.40 Definition of incorrect collection.
42:5.0.1.1.7.4.23.2SECTION 489.41
   489.41 Timing and methods of handling.
42:5.0.1.1.7.4.23.3SECTION 489.42
   489.42 Payment of offset amounts to beneficiary or other person.
42:5.0.1.1.7.5SUBPART E
Subpart E - Termination of Agreement and Reinstatement After Termination
42:5.0.1.1.7.5.23.1SECTION 489.52
   489.52 Termination by the provider.
42:5.0.1.1.7.5.23.2SECTION 489.53
   489.53 Termination by CMS.
42:5.0.1.1.7.5.23.3SECTION 489.54
   489.54 Termination by the OIG.
42:5.0.1.1.7.5.23.4SECTION 489.55
   489.55 Exceptions to effective date of termination.
42:5.0.1.1.7.5.23.5SECTION 489.57
   489.57 Reinstatement after termination.
42:5.0.1.1.7.6SUBPART F
Subpart F - Surety Bond Requirements for HHAs
42:5.0.1.1.7.6.23.1SECTION 489.60
   489.60 Definitions.
42:5.0.1.1.7.6.23.2SECTION 489.61
   489.61 Basic requirement for surety bonds.
42:5.0.1.1.7.6.23.3SECTION 489.62
   489.62 Requirement waived for Government-operated HHAs.
42:5.0.1.1.7.6.23.4SECTION 489.63
   489.63 Parties to the bond.
42:5.0.1.1.7.6.23.5SECTION 489.64
   489.64 Authorized Surety and exclusion of surety companies.
42:5.0.1.1.7.6.23.6SECTION 489.65
   489.65 Amount of the bond.
42:5.0.1.1.7.6.23.7SECTION 489.66
   489.66 Additional requirements of the surety bond.
42:5.0.1.1.7.6.23.8SECTION 489.67
   489.67 Term and type of bond.
42:5.0.1.1.7.6.23.9SECTION 489.68
   489.68 Effect of failure to obtain, maintain, and timely file a surety bond.
42:5.0.1.1.7.6.23.10SECTION 489.69
   489.69 Evidence of compliance.
42:5.0.1.1.7.6.23.11SECTION 489.70
   489.70 Effect of payment by the Surety.
42:5.0.1.1.7.6.23.12SECTION 489.71
   489.71 Surety's standing to appeal Medicare determinations.
42:5.0.1.1.7.6.23.13SECTION 489.72
   489.72 Effect of review reversing determination.
42:5.0.1.1.7.6.23.14SECTION 489.73
   489.73 Effect of conditions of payment.
42:5.0.1.1.7.6.23.15SECTION 489.74
   489.74 Incorporation into existing provider agreements.
42:5.0.1.1.7.7SUBPART G
Subparts G-H [Reserved]
42:5.0.1.1.7.8SUBPART I
Subpart I - Advance Directives
42:5.0.1.1.7.8.23.1SECTION 489.100
   489.100 Definition.
42:5.0.1.1.7.8.23.2SECTION 489.102
   489.102 Requirements for providers.
42:5.0.1.1.7.8.23.3SECTION 489.104
   489.104 Effective dates.