2006 proposed fee schedule - American Society of Clinical Oncology

2006 proposed fee schedule - American Society of Clinical Oncology 2006 proposed fee schedule - American Society of Clinical Oncology

19.02.2013 Views

362 For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services proposes to amend 42 CFR chapter IV as set forth below: PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED 1. The authority citation for part 405 continues to read as follows: Authority: Secs. 1102, 1861, 1862(a), 1871, 1874, 1881, and 1886(k) of the Social Security Act (42 U.S.C. 1302, 1395x, 1395y(a), 1395hh, 1395kk, 1395rr, and 1395ww(k)), and sec. 353 of the Public Health Service Act (42 U.S.C. 263a). Subpart D--Private Contracts 2. Section 405.435 is amended by-- A. Revising introductory text in paragraph (b). B. Adding paragraph (d). The revision and addition read as follows: §405.435 Failure to maintain opt-out. * * * * * (b) If a physician or practitioner fails to maintain opt-out in accordance with paragraph (a) of this section, then, for the remainder of the opt-out period, except as provided by paragraph (d) of this section-- * * * * * (d) If a physician or practitioner demonstrates that he or she has taken good faith efforts to maintain opt-out

(including by refunding amounts in excess of the charge 363 limits to beneficiaries with whom he or she did not sign a private contract) within 45 days of a notice from the carrier of a violation of paragraph (a) of this section, then the requirements of paragraphs (b)(1) through (b)(8) of this section are not applicable. In situations where a violation of paragraph (a) of this section is not discovered by the carrier during the 2-year opt-out period when the violation actually occurred, then the requirements of paragraphs (b)(1) through (b)(8) of this section are applicable from the date that the first violation of paragraph (a) of this section occurred until the end of the opt-out period during which the violation occurred (unless the physician or practitioner takes good faith efforts, within 45 days of any notice from the carrier that the physician or practitioner failed to maintain opt-out, or the physician’s or practitioner’s discovery of the failure to maintain opt-out, whichever is earlier, to correct his or her violations of paragraph (a) of this section, for example, by refunding the amounts in excess of the charge limits to beneficiaries with whom he or she did not sign a private contract). * * * * * Subpart X--Rural Health Clinic and Federally Qualified Health Center Services

(including by refunding amounts in excess <strong>of</strong> the charge<br />

363<br />

limits to beneficiaries with whom he or she did not sign a<br />

private contract) within 45 days <strong>of</strong> a notice from the<br />

carrier <strong>of</strong> a violation <strong>of</strong> paragraph (a) <strong>of</strong> this section,<br />

then the requirements <strong>of</strong> paragraphs (b)(1) through (b)(8) <strong>of</strong><br />

this section are not applicable. In situations where a<br />

violation <strong>of</strong> paragraph (a) <strong>of</strong> this section is not discovered<br />

by the carrier during the 2-year opt-out period when the<br />

violation actually occurred, then the requirements <strong>of</strong><br />

paragraphs (b)(1) through (b)(8) <strong>of</strong> this section are<br />

applicable from the date that the first violation <strong>of</strong><br />

paragraph (a) <strong>of</strong> this section occurred until the end <strong>of</strong> the<br />

opt-out period during which the violation occurred (unless<br />

the physician or practitioner takes good faith efforts,<br />

within 45 days <strong>of</strong> any notice from the carrier that the<br />

physician or practitioner failed to maintain opt-out, or the<br />

physician’s or practitioner’s discovery <strong>of</strong> the failure to<br />

maintain opt-out, whichever is earlier, to correct his or<br />

her violations <strong>of</strong> paragraph (a) <strong>of</strong> this section, for<br />

example, by refunding the amounts in excess <strong>of</strong> the charge<br />

limits to beneficiaries with whom he or she did not sign a<br />

private contract).<br />

* * * * *<br />

Subpart X--Rural Health Clinic and Federally Qualified<br />

Health Center Services

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