§411.8. Services paid for by a Government entity.
42 C.F.R. § 411.8
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.
Exceptions. Payment may be made for the following:
Services furnished under a health insurance plan established for employees of the government entity.
Services furnished under a title of the Social Security Act other than title XVIII.
Services furnished in or by a participating general or special hospital that—
Is operated by a State or local government agency; and
Serves the general community.
Services furnished in a hospital or elsewhere, as a means of controlling infectious diseases or because the individual is medically indigent.
Services furnished by a participating hospital or SNF of the Indian Health Service.
Services furnished by a public or private health facility that—
Is not a Federal provider or other facility operated by a Federal agency;
Receives U.S. government funds under a Federal program that provides support to facilities that furnish health care services;
Customarily seeks payment for services not covered under Medicare from all available sources, including private insurance and patients' cash resources; and
Limits the amounts it collects or seeks to collect from a Medicare Part B beneficiary and others on the beneficiary's behalf to:
Any unmet deductible applied to the charges related to the reasonable costs that the facility incurs in providing the covered services;
Twenty percent of the remainder of those charges;
The charges for noncovered services.
Rural health clinic services that meet the requirements set forth in part 491 of this chapter.
Notes, amendments, and revision history
Amendments
[54 FR 41734, Oct. 11, 1989, as amended at 56 FR 2139, Jan. 22, 1991]
Authority
Authority: 42 U.S.C. 1302, 1395w-101 through 1395w-152, 1395hh, and 1395nn.
Source
Source: 54 FR 41734, Oct. 11, 1989, unless otherwise noted.
Amendments
[54 FR 41734, Oct. 11, 1989, as amended at 56 FR 2139, Jan. 22, 1991]