Recipients of training grants under section 303 of the Act that provide a clinical traineeship to any individual must: (a) Give each such individual written notice of the service payback and recovery requirements of this part at the time the individual becomes a candidate for the traineeship; (b) Before awarding a clinical traineeship, conduct an entrance interview with the individual in order to

(a) Grounds for terminating a qualified entity agreement. CMS may terminate an agreement with a qualified entity if CMS determines the qualified entity or its contractor meets any of the following: (1) Engages in one or more serious violations of the requirements of this subpart. (2) Fails to completely and accurately report information to CMS or fails to make

, CMS may terminate the agreement with 30 days advance notice. (2) If the State or local government agency fails to comply with the terms of the agreement or procedures promulgated by CMS, CMS may terminate the agreement with 30 days advance notice. (3) If CMS finds that the State or local government agency is not acting in the best interest of the enrollees, or CMS, or for any reason other than those in paragraphs (b)(1) and (b

and the major procedures performed on the patient, as attested to by the patient's attending physician by virtue of his or her signature in the medical record. Anyone who misrepresents, falsifies, or conceals essential information required for payment of Federal funds, may be subject to fine, imprisonment, or civil penalty under applicable Federal laws. (3) Completion of

agreement, he or she will offer the intermediary an opportunity for a hearing, in accordance with §421.128. (3) If the intermediary does not request a hearing, or if the hearing decision affirms the Secretary's decision, the Secretary will provide reasonable notice of the effective date of termination to— (i) The intermediary;

an MA organization unless— (i) At least 45 days (or 10 days if using certain types of marketing materials that use, without modification, proposed model language and format, including standardized language and formatting, as specified by CMS) before the date of distribution the MA organization has submitted the material or form to CMS for review under the guidelines in

(1) Documents and records must be maintained for 10 years from the date such calculations were reported to CMS with respect to a given MLR reporting year. (2) MA organizations must require any third party vendor supplying drug or medical cost contracting and claim adjudication services to the MA organization to provide all underlying data associated with MLR reporting to that MA organization in a timely manner, when requested by the MA organization

— (i) At least 45 days (or 10 days if using certain types of marketing materials that use, without modification, proposed model language and format, including standardized language and formatting, as specified by CMS) before the date of distribution, the Part D sponsor submits the material or form to CMS for review under the guidelines in §423.2264 of this subpart

(1) Documents and records must be maintained for 10 years from the date such calculations were reported to CMS with respect to a given contract year. (2) Part D sponsors must require any third party vendor supplying drug cost contracting and claim adjudication services to the Part D sponsors to provide all underlying data associated with MLR reporting to that Part D sponsor in a timely manner, when requested by the Part D sponsor, regardless of current

arrangement to the employer or contracting entity, provided that the employees and contractors remain free to make referrals without restriction or limitation if the beneficiary expresses a preference for a different provider, practitioner, or supplier; the beneficiary's insurer determines the provider, practitioner, or supplier; or the referral is not in the beneficiary's best medical interests in the judgment of the referring party. [83 FR 68067, Dec. 31

the following: (1) Use template language developed by CMS, if available. (2) Not be used in a discriminatory manner or for discriminatory purposes. (3) Comply with §425.304 regarding beneficiary incentives. (4) Not be materially inaccurate or misleading.

§425.312. (2) The notifications provided under §425.312 must state that the ACO may have requested beneficiary identifiable claims data about the beneficiary for purposes of its care coordination and quality improvement work, and inform the beneficiary how to decline having his or her claims information shared

38 U.S.C. 8126. (c) Rule of construction. Nothing in this section is construed to alter any existing statutory or regulatory prohibition on services for an entity described paragraph (a)(5) of this section, including the prohibition set forth in section 1008 of the PHSA.

determination or change as a result of a DRG validation. (c) Fraud and abuse. (1) A QIO or its subcontractor may review and deny payment anytime there is a finding that the claim for service involves fraud or a similar abusive practice that does not support a finding of fraud. (2) An initial denial determination or change as a result of a DRG validation may be reopened

request. A QIO is authorized to require the receipt of the medical information sooner if the QIO makes a preliminary determination that the review involves a potential gross and flagrant or substantial quality of care concern and circumstances warrant earlier receipt of the medical information. A practitioner's or provider's failure to comply with the request for medical information within the established timeframe may result in the QIO taking action in accordance with

pancreas transplants alone or subsequent to a kidney transplant as well as kidney-pancreas transplants. Transplant hospital means a hospital that furnishes organ transplants and other medical and surgical specialty services required for the care of transplant patients. Transplant program means an organ-specific transplant program within a transplant hospital

, for which the statute authorizes CMS to impose a sanction. Plan of correction means a plan developed by the HHA and approved by CMS that is the HHA's written response to survey findings detailing corrective actions to cited deficiencies and specifies the date by which those deficiencies will be corrected. Repeat deficiency means a condition-level citation

) Notification to Inspector General. (1) The Medicaid agency must notify the Inspector General of any disclosures made under paragraph (a) of this section within 20 working days from the date it receives the information. (2) The agency must promptly notify the Inspector General of any action it takes on the provider's application for participation in the program.

(a) Adjustments to basis must be made for exhaustion, wear and tear, obsolescence, amortization, and depletion to the extent actually sustained in respect of: (1) Any period before March 1, 1913, (2) Any period since February 28, 1913, during which the property was held by a person or organization not subject to income taxation under chapter 1 of the Code or prior income tax laws,

(i) Employment taxes. (ii) Miscellaneous excise taxes collected by return. (3) The difference between these two main classes is that only taxes described in subparagraph (1) of this paragraph, i.e., those within the jurisdiction of the Tax Court, may be contested before an independent tribunal prior to payment. Taxes of both classes may be contested by first making payment, filing claim for refund

The airplane must be designed for loads resulting from the yaw maneuver conditions specified in paragraphs (a) through (d) of this section at speeds from VMC to VD. Unbalanced aerodynamic moments about the center of gravity must be reacted in a rational or conservative manner considering the airplane inertia forces. In computing the tail loads the yawing

y0 is the y coordinate of the Planckian radiator for the value of x considered. [Doc. No. 5066, 29 FR 18291, Dec. 24, 1964, as amended by Amdt. 25-27, 36 FR 12972, July 10, 1971]

section must be performed on the same engine, but this engine need not be the same engine used for the tests required by §33.87. (e) The tests required by paragraphs (a), (b), and (c) of this section must be followed by engine disassembly to the extent necessary to show compliance with the requirements of

Ear, nose, throat, and equilibrium standards for a third-class airman medical certificate are: (a) The person shall demonstrate acceptable hearing by at least one of the following tests: (1) Demonstrate an ability to hear an average conversational voice in a quiet room, using both ears, at a distance of 6 feet from the examiner, with the back turned to the examiner.

(a) The ratings listed in paragraph (b) of this section may be issued to an applicant for: (1) A pilot school certificate, provided the applicant meets the requirements of §141.5 of this part; or (2) A provisional pilot school certificate, provided the applicant meets the requirements of

of any objection to, or approval of, the proposed project made known to the sponsor by any local individual, group or community; and (2) A written statement showing that adequate replacement housing that is open to all persons, regardless of race, color, religion, sex, or national origin, is available and has been offered on the same nondiscriminatory basis to persons who have resided on land physically acquired or to be acquired for the project development and