Limitations on Payment for Services Covered Under Group Health Plans: General Provisions

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Medicare Program
  6. Exclusions from Medicare and Limitations on Medicare Payment
  7. Limitations on Payment for Services Covered Under Group Health Plans: General Provisions

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Section
411.100

Basis and scope.

Section
411.101

Definitions.

Section
411.102

Basic prohibitions and requirements.

Section
411.103

Prohibition against financial and other incentives.

Section
411.104

Current employment status.

Section
411.106

Aggregation rules.

Section
411.108

Taking into account entitlement to Medicare.

Section
411.110

Basis for determination of nonconformance.

Section
411.112

Documentation of conformance.

Section
411.114

Determination of nonconformance.

Section
411.115

Notice of determination of nonconformance.

Section
411.120

Appeals.

Section
411.121

Hearing procedures.

Section
411.122

Hearing officer's decision.

Section
411.124

Administrator's review of hearing decision.

Section
411.126

Reopening of determinations and decisions.

Section
411.130

Referral to Internal Revenue Service (IRS).