proportion of Medicare beneficiaries to the total State population, and 15 percent is based on the percentage of the State's Medicare beneficiary population that resides in rural areas.

(d) Allocation of remaining funds. (1) HCFA may transfer funds not awarded under this section to the basic grant funds described in § 403.502, and may allocate these funds to States that have been awarded basic grant funds under this section, using the calculation described in §403.504(c) for the variable portion of basic grants.

(2) If the amount of a grant under this section differs from a State's original budget request, the State must submit a revised budget and project plan to reflect the amount of the funding under this section.

(a) General. HCFA awards supplemental grants to States for intensive, innovative approaches to making information, counseling and/or assistance with coordinated care benefits available to Medicare beneficiaries. A State must receive a basic grant to qualify for a supplemental coordinated care grant. Each State eligible to apply for a supplemental grant that submits an acceptable proposal receives a grant.

(b) Funding. HCFA awards supplemental grants from a pool of $1,000,000. HCFA bases the amount awarded to States that have Medicare Coordinated Care plans on the following:

(1) The budget submitted by the State.

(2) The number of States qualifying for funds under this section.

(3) The number of coordinated care plans in those States qualifying for funds under this section.

(c) Allocation of remaining funds. (1) HCFA may transfer funds not awarded under this section to the basic grant funds described in § 403.502, and may allocate the funds to States that have been awarded basic grant funds under

this section, using the calculation described in §403.504(c) for the variable portion of basic grants.

(2) If the amount of a grant under this section differs from a State's original budget request, the State must submit a revised budget and project plan to reflect the amount of the funding under this section.

§ 403.508 Limitations.

(a) Use of grants. A State that receives a grant under this subpart may use the grant for any reasonable expenses incurred in planning, developing, implementing, and/or operating the program for which the grant is made.

(b) Maintenance of effort. A State that receives a grant to supplement an existing program (see § 403.504(a)(2) of this subpart) must not use the grant to supplant funds for activities that were conducted immediately preceding the date of the award of the grant and funded through other sources (including in-kind contributions), but must maintain the activities of the program at least at the level that those activities were conducted immediately preceding that date.

(c) Awarding of grants. Grants will be awarded by September 30, 1992 for all State applications approved by that date.

(d) Annual report. A State that receives a grant under this subpart E must, not later than 180 days after receiving the grant, and annually thereafter, submit a report to HCFA that includes information on:

(1) The number of individuals served by the program.

(2) An estimate of the amount of funds saved by the State and eligible individuals in the State, as a result of the program.

(3) The problem that eligible individuals in the State encounter in procuring adequate and appropriate health

care.

405.353 Certification of amount that will be

adjusted against individual title II or railroad retirement benefits.

405.354 Procedures for adjustment or recovery-title II beneficiary.

405.355 Waiver of adjustment or recovery. 405.356 Principles applied in waiver of, adjustment or recovery.

405.359 Liability of certifying or disbursing

officer.

SUSPENSION OF PAYMENT TO PROVIDERS AND SUPPLIERS AND COLLECTION AND COMPROMISE OF OVERPAYMENTS

405.370 Suspension of payments to providers of services and other suppliers of services.

405.371 Proceeding for suspension. 405.372 Submission of evidence and notification of administrative determination to suspend.

405.373 Subsequent action by intermediary or carrier.

405.374 Collection and compromise of claims for overpayments.

405.375 Withholding Medicare payments to recover Medicaid overpayments. 405.376 Interest charges on overpayment and underpayments to providers, suppliers, and other entities.

REPAYMENT OF SCHOLARSHIPS AND LOANS 405.380 Collection of past-due amounts on scholarship and loan programs.

Subpart D-Principles of Reimbursement for Services by Hospital-Based Physicians PAYMENTS TO TEACHING HOSPITALS 405.465 Determining reimbursement for certain physician and medical school faculty services rendered in teaching hospitals.

405.466 Payment to a fund.

PAYMENT FOR SERVICES OF PHYSICIANS TO PROVIDERS

405.480 Payment for services of physicians to providers: General rules. 405.481

Allocation of physician compensation costs.

405.482 Limits on compensation for services of physicians in providers.

Subpart E-Criteria for Determination of Reasonable Charges; Payment for Services of Hospital Interns, Residents, and Supervising Physicians

405.501 Determination

charges.

of

reasonable

405.502 Criteria for determining reasonable charges.

405.503 Determining customary charges. 405.504 Determining prevailing charges. 405.505 Determination of locality 405.506 Charges higher than customary or prevailing charges or lowest charge levels.

405.507 Illustrations of the application of the criteria for determining reasonable charges.

405.508 Determination of comparable circumstances; limitation.

405.509 Determining the inflation-indexed charge.

405.511 Reasonable charges for medical services, supplies, and equipment. 405.512 Carriers' procedural terminology and coding systems.

405.515 Reimbursement for clinical laboratory services billed by physicians. 405.517 Payment for drugs that are not paid on a cost or prospective payment basis. 405.520 Reimbursement for services of interns, residents and supervising physicians; general.

405.521 Services of attending physicians supervising interns and residents. 405.522 Intern and resident services in approved teaching programs.

405.523 Interns' and residents' services not in approved teaching programs.

Subparts O and P (Reserved)

Subpart Q-Conditions of Participation: Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and/or Speech Pathology Services; and Conditions for Coverage: Outpatient Physical Therapy Services Furnished by Physical Therapists in Independent Practice

CONDITIONS OF PARTICIPATION: CLINICS, REHABILITATION AGENCIES, AND PUBLIC HEALTH AGENCIES AS PROVIDERS OF OUTPATIENT PHYSICAL THERAPY AND/OR SPEECH PATHOLOGY SERVICES

405.1701 Conditions of participation-general.

405.1702 Definitions relating to clinics, rehabilitation agencies, and public health agencies.

405.1715 Condition of participation-compli

ance with Federal, State, and local laws. 405.1716 Condition of participation-administrative management.

405.1717 Condition of participation-plan of care and physician involvement. 405.1718 Condition of participation-physical therapy services.

405.1719 Condition of participation-speech pathology services.

405.1720 Condition of participation-rehabilitation program. 405.1721 Condition of participation-ar

rangements for physical therapy and speech pathology services to be performed by other than salaried organization personnel.

405.1722 Condition of participation-clinical

records.

405.1723 Condition of participation-phys

ical environment.

405.1724 Condition of participation-infec

tion control.

Introduction.

405.1801 405.1803 Intermediary determination and notice of amount of program reimbursement.

405.1804 Matters not subject to administrative or judicial review under prospective payment.

405.1805 Parties to intermediary determination.

405.1807 Effect of intermediary determination.

405.1809 Intermediary hearing procedures. 405.1811 Right to intermediary hearing;

time, place, form, and content of request for intermediary hearing.

405.1813 Failure to timely request an intermediary hearing.

405.1815 Parties to the intermediary hearing.

405.1817 Hearing officer or panel of hearing officers authorized to conduct intermediary hearing; disqualification of officers.

405.1819 Conduct of intermediary hearing. 405.1821 Prehearing discovery and other proceedings prior to the intermediary hearing.

405.1823 Evidence at intermediary hearing. 405.1825 Witnesses at intermediary hearing. 405.1827 Record of intermediary hearing. 405.1829 Authority of hearing officer(s) at intermediary hearing.

405.1831 Intermediary hearing decision and notice.

405.1833 Effect of intermediary hearing decision.

405.2161 Condition: Director of a renal dialysis facility or renal dialysis center. 405.2162 Condition: Staff of a renal dialysis facility or renal dialysis center. 405.2163 Condition: Minimal service require

ments for a renal dialysis facility or renal dialysis center.

405.2164 Conditions for coverage of special purpose renal dialysis facilities.

405.2170 Condition: Director of a renal transplantation center.

405.2171 Condition: Minimal service requirements for a renal transplantation center. 405.2180 Termination of Medicare coverage. 405.2181 Alternative sanctions. 405.2182 Notice of sanction and rights: Termination of coverage. 405.2184 Notice of appeal rights: Alternative sanctions.

Subparts V-W (Reserved)

appeal