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.

• 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.

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

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