(a) Type of services that may be available. Services for the Indian community served by the local facilities and program may include hospital and medical care, dental care, public health nursing and preventive care (including immunizations), and health examination of special groups such as school children. (b) Where services are available. Available services

be charged at rates approved by the Assistant Secretary for Health and Surgeon General published in the Federal Register. Reimbursement from third-party payors may be arranged by the patient or by the Service on behalf of the patient. [64 FR 58319, Oct. 28, 1999. Redesignated and amended at 67 FR 35342, May 17, 2002]

administrative record prepared by the Federal agency. The judge gives appropriate deference to the agency's decisions and does not substitute the court's views for those of the agency. Jury trials and civil discovery are not permitted in APA proceedings. If a Federal agency has failed to comply with NEPA or NHPA, the judge may grant declaratory or injunctive relief to the interested party. No money damages or fines are permitted in APA proceedings.

. Failure of the debtor to make payment, as provided by the compromise agreement, reinstates the full amount of the claim, less any amounts paid prior to the default. (c) Prohibition against grace periods. CMS will not agree to inclusion of a provision in an installment agreement that would permit grace periods for payments that are late under the terms of the agreement.

are met, CMS will— (1) Certify the policy; and (2) Authorize the insuring organization to display the emblem on the policy, as provided for in §403.231. (c) If CMS certifies a policy, it will inform all State Commissioners and Superintendents of Insurance of that fact.

order to be entitled or deemed to be entitled to Medicare on the basis of disability.) Family member means a person who is enrolled in an LGHP based on another person's enrollment; for example, the enrollment of the named insured individual. Family members may include a spouse (including a divorced or common-law spouse), a natural, adopted, foster, or stepchild, a parent, or a sibling.

(a) Timing. The MGCRB notifies the parties in writing, with a copy to CMS, and issues a decision within 180 days after the first day of the 13-month period preceding the Federal fiscal year for which a hospital has filed a complete application. The hospital has 15 days from the date of the decision to request Administrator review. (b) Appeal. The decision of

§405.1875 of this chapter, shall have the authority to determine the issues raised. The methods and standards for the calculation of the statutorily defined payment rates by CMS are not subject to appeal. [74 FR 39414, Aug. 6, 2009, as amended at 78 FR 48281, Aug. 7, 2013]

section in 2001 for payments made in 2002.

CMS will acquire from quality improvement organizations (QIOs) as defined in part 475 of this chapter data collected under section 1886(b)(3)(B)(viii) of the Act and subject to the requirements in §480.140(g). CMS will acquire this information, as needed, and may use it for the following functions: (a) Enable beneficiaries to compare

, acquired, or generated by a QIO in the performance of its responsibilities under this section is subject to the confidentiality provisions of part 480 of this chapter. Part D sponsors are required to provide specified information to CMS for distribution to the QIOs as well as directly to QIOs. (c) Applicability of QIO confidentiality provisions. The provisions of part 480 of this chapter apply to Part D sponsors in the same manner

This subpart establishes the procedures for reviewing the following contract determinations: (a) A determination that an entity is not qualified to enter into a contract with CMS under Part D of title XVIII of the Act. (b) A determination not to authorize a renewal of a contract with a PDP sponsor in accordance with

Non-claims costs means those expenses for administrative services that are not— (1) Incurred claims (as provided in §423.2420(b)(2) through (b)(4)); (2) Expenditures on quality improving activities (as provided in

(a) This subpart sets forth the rules for hearings to States that appeal a decision to disapprove State plan material (under §430.18) or to withhold Federal funds (under §430.35), because the State plan or State practice in the Medicaid program is not in compliance with

For the purposes of this subpart: Demonstration means any experimental, pilot, or demonstration project which the Secretary approves under the authority of section 1115 of the Act because, in the judgment of the Secretary, it is likely to assist in promoting the statutory objectives of the Medicaid or CHIP program. Indian Health

The agency may provide Medicaid to any group or groups of individuals in the community who meet the following requirements: (a) The group would be eligible for Medicaid if institutionalized. (b) In the absence of home and community-based services under a waiver granted under part 441— (1) Subpart G of this subchapter, the group would otherwise require the level of

The agency may provide Medicaid to any group or groups of individuals in the community who meet the following requirements: (a) The group would be eligible for Medicaid if institutionalized. (b) In the absence of home and community-based services under a waiver granted under part 441— (1) Subpart G of this subchapter, the group would otherwise require the level of

reversing the determination. (b) Services furnished while the appeal is pending. If the MCO, PIHP, or PAHP, or the State fair hearing officer reverses a decision to deny authorization of services, and the enrollee received the disputed services while the appeal was pending, the MCO, PIHP, or PAHP, or the State must pay for those services, in accordance with State policy and regulations.

(a) If the plan includes services in public institutions for mental diseases, the agency must show that the State is making satisfactory progress in developing and implementing a comprehensive mental health program. (b) The program must— (1) Cover all ages; (2) Use mental health and public welfare resources; including— (i

provisions regarding State plan requirements and options for cost sharing. (b) Scope. This subpart consists of provisions relating to the imposition under a separate child health program of cost-sharing charges including enrollment fees, premiums, deductibles, coinsurance, copayments, and similar cost-sharing charges. (c) Applicability. The requirements of this

(a) Effective date. A participant's voluntary disenrollment is effective on the first day of the month following the date the PACE organization receives the participant's notice of voluntary disenrollment. (b) Reasons for voluntary disenrollment. A PACE participant may voluntarily disenroll from the program without cause at any time.

For inpatient services, a hospital that participates in the Medicare program must participate in any health plan contracted under 10 U.S.C. 1079 or 1086 (Civilian Health and Medical Program of the Uniformed Services) and under 38 U.S.C. 613 (Civilian Health and Medical Program

The clinical consultant must be qualified to consult with and render opinions to the laboratory's clients concerning the diagnosis, treatment and management of patient care. The clinical consultant must— (a) Be qualified as a laboratory director under §493.1443(b)(1), (2), or (3)(i) or, for the subspecialty of oral pathology,

(a) Whenever a penalty, an assessment, or an exclusion becomes final, the following organizations and entities will be notified about such action and the reasons for it: The appropriate State or local medical or professional association; the appropriate quality improvement organization; as appropriate, the State agency that administers each State health care program; the appropriate Medicare carrier or intermediary; the appropriate State or local licensing agency or

makes qualified payments to a designated settlement fund under section 468B, relating to special rules for designated settlement funds. (c) Payments to other funds or persons that constitute economic performance. [Reserved] (d) Effective dates. The rules in paragraph (a) of this section apply to payments after July 18, 1984.

Prior to September 28, 1962, for purposes of sections 582 and 584, the term bank means a bank or trust company incorporated and doing business under the laws of the United States (including laws relating to the District of Columbia), of any State, or of any Territory, a substantial part of the business of which consists of receiving deposits and making loans and discounts, or of exercising fiduciary powers similar to those

Section 511 of the Act applies with respect to vessels operated in the foreign or domestic commerce of the United States or in the fisheries of the United States and vessels acquired or being constructed for the purpose of such operation. The foreign commerce of the United States includes commerce or trade between the United States (including the District of Columbia), the territories and possessions which are embraced within the coastwise laws, and a foreign country or other territories and

from the definition of “wages” pursuant to section 3306(b) (1) through (16). For example, a fringe benefit provided to or on behalf of an employee is excluded from the definition of “wages” if at the time such benefit is provided it is reasonable to believe that the employee will be able to exclude such benefit from income under section 117 or 132. [T.D. 8004, 50 FR 755, Jan. 7, 1985]

excluded from the definition of “wages” pursuant to section 3401(a) (1) through (20). For example, a fringe benefit provided to or on behalf of an employee is excluded from the definition of “wages” if at the time such benefit is provided it is reasonable to believe that the employee will be able to exclude such benefit from income under section 117 or 132. [T.D. 8004, 50 FR 756, Jan. 7, 1985]

to sign in accordance with the regulations, forms, or instructions prescribed with respect to such statement or document. An individual's signature on a return, statement, or other document made by or for the real estate investment trust or the regulated investment company shall be prima facie evidence that the individual is authorized to sign the return, statement, or other document. [T.D. 8180, 53 FR 6148, Mar. 1, 1988]