Services paid for by a Government entity.

42 CFR § 411.8

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19 segments

42 CFR § 411.8

(a)

Basic rule. Except as provided in paragraph (b) of this section, Medicare does not pay for services that are paid for directly or indirectly by a government entity.

(b)

Exceptions. Payment may be made for the following:

(1)

Services furnished under a health insurance plan established for employees of the government entity.

(2)

Services furnished under a title of the Social Security Act other than title XVIII.

(3)

Services furnished in or by a participating general or special hospital that—

(i)

Is operated by a State or local government agency; and

(ii)

Serves the general community.

(4)

Services furnished in a hospital or elsewhere, as a means of controlling infectious diseases or because the individual is medically indigent.

(5)

Services furnished by a participating hospital or SNF of the Indian Health Service.

(6)

Services furnished by a public or private health facility that—

(i)

Is not a Federal provider or other facility operated by a Federal agency;

(ii)

Receives U.S. government funds under a Federal program that provides support to facilities that furnish health care services;

(iii)

Customarily seeks payment for services not covered under Medicare from all available sources, including private insurance and patients' cash resources; and

(iv)

Limits the amounts it collects or seeks to collect from a Medicare Part B beneficiary and others on the beneficiary's behalf to:

(A)

Any unmet deductible applied to the charges related to the reasonable costs that the facility incurs in providing the covered services;

(B)

Twenty percent of the remainder of those charges;

(C)

The charges for noncovered services.

(7)

Rural health clinic services that meet the requirements set forth in part 491 of this chapter.

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