Sec. 405.655 Notification of selection or nonselection of nominated agency or organization. 405.656 Withdrawal of nomination or election. 405.658 Emergency hospital services; hospital election to receive health insurance payments. 405.659 Reinstatement of emergency service hospital after notice of failure to continue to comply. 405.660 Criteria considered by Secretary in determining whether to enter into an agreement pursuant to section 1816 with a nominated agency or organization. 405.662 Termination by intermediary. 405.663 Termination by Secretary. 405.670 Contracts with carriers pursuant to section 1842; general. 405.671 Carrier; defined. 405.672 Competitive bidding for contract not required. 405.673 Carrier's ability to perform duties; financial responsibility; etc. 405.675 Termination of section 1842 contract by notice of nonrenewal. 405.676 Termination of section 1842 contract by Secretary for cause. 405.677 Functions which a carrier may perform under contract with the Secretary. 405.678 Duties to be performed by a carri er. 405.685 Agreements with States pursuant to section 1864; general. Subpart G-Reconsiderations and Appeals Under the Hospital Insurance Program 405.701 General. 405.702 Notice of initial determination. 405.704 Actions which are initial determi nations. 405.705 Actions which are not initial determinations. 405.706 Decisions of utilization review com mittees. 405.708 Effect of initial determination. 405.710 Right to reconsideration. 405.711 Time and place of filing request for reconsideration. 405.712 Extension of time to request recon sideration. 405.714 Withdrawal of request for recon sideration. 405.715 Reconsidered determination. 405.716 Notice of reconsidered determination. 405.717 Effect of a reconsidered determination. 405.718 Expedited appeals process; conditions for use of such process. 405.718a Expedited appeals process; place and time of filing request. 405.718b Expedited appeals process; parties. 405.718c Expedited appeals process; agreement requirements. 405.745 Amount in controversy ascertained after reconsideration. 405.747 Dismissal of request for hearing; amount in controversy less than $100. 405.750 Time period for reopening initial, revised, or reconsidered determinations and decisions or revised decisions of a presiding officer or the Appeals Council; finality of determinations and decisions. Subpart H-Review and Hearing Under the Supplementary Medical Insurance Program 405.801 Title XVIII, Part B-General. 405.802 Definitions. 405.803 Initial determination. 405.804 Notice of initial determination. 405.805 Parties to the initial determination. 405.806 Effect of initial determination. 405.807 Review of initial determination. 405.808 Parties to the review. 405.809 Opportunity to submit evidence. 405.810 Review determination. 405.821 Request for hearing. 405.822 Parties to a hearing. 405.823 Hearing officer. 405.824 Disqualification of hearing officer. 405.825 Location of hearing. 405.826 Notice of hearing. 405.830 Conduct of the hearing. 405.831 Waiver of right to appear and present evidence. 405.832 Dismissal of request for hearing. 405.833 Record of hearing. 405.834 Hearing officer's decision. 405.835 Effect of hearing officer's decision. 405.841 Reopening initial or review deter mination of the carrier, and decision of a hearing officer. 405.842 Notice of reopening and revision. 405.850 Change of ruling or legal precedent. 405.860 Authority of the hearing officer. 405.870 Appointment of representative. 405.871 Qualifications of representatives. 405.872 Authority of representatives. while 405.912 Collection of premiums monthly benefits are suspended. 405.913 Collection of overdue premiums for months in a closed taxable year. 405.914 Payment within the grace period. 405.915 Possible entitlement to social security or railroad retirement benefits. 405.916 Effect of entitlement to age-72 special payment. 405.920 Premium payment; individual not entitled to monthly benefits and not enrolled pursuant to Federal-State agreement. 405.921 Payment of premium on monthly or 3-month basis. 405.927 Due date and grace period. 405.928 Extension where last day of grace period is a nonworkday. 405.929 Extension of grace period for good 405.1028 Condition of participation-Laboratories. 405.1029 Condition of participation-Radiology department. 405.1030 Condition of participation-Medical library. 405.1031 Condition of participation-Complementary departments. 405.1032 Condition of participation-Outpatient department. 405.1033 Condition of participation-Emergency service or department. 405.1034 Condition of participation-Social work department. 405.1035 Condition of participation-Utilization review plan. 405.1036 Special rules and exceptions applying to psychiatric and tuberculosis hospitals. 405.1037 Condition of participation-Special medical record requirements for psychiatric hospitals. 405.1038 Condition of participation-Special staff requirements for psychiatric hospitals. 405.1039 Condition of participation-Spe cial medical record requirements for tuberculosis hospitals. 405.1040 Condition of participation-Special staff requirements for tuberculosis hospitals. Sec. 405.1127 Condition of participation-pharmaceutical services. 405.1128 Condition of participation—laboratory and radiologic services. 405.1129 Condition of participation-dental services. 405.1130 Condition of participation-social services. 405.1131 Condition of participation-patient activities. 405.1132 Condition of participation-medical records. 405.1133 Condition of participation-transfer agreement. 405.1134 Condition of participation-physical environment. 405.1135 Condition of participation-infection control. 405.1136 Condition of participation-disaster preparedness. 405.1137 Condition of participation-utilization review. Subpart L-Conditions of Participation; Home Health Agencies 405.1201 General. 405.1202 Definitions. 405.1220 Condition of participation: Compliance with Federal, State, and local laws. 405.1221 Condition of participation: Organization, services, administration. 405.1222 Condition of participation: Group of professional personnel. 405.1223 Condition of participation: Acceptance of patients, plan of treatment, medical supervision. 405.1224 Condition of participation: Skilled nursing service. 405.1225 Condition of participation: Therapy services. 405.1226 Condition of participation: Medical social services. 405.1227 Condition of participation: Home health aide services. 405.1228 Condition of participation: Clinical records. 405.1229 Condition of participation: Evaluation. 405.1230 Condition of participation: Quali fying to provide outpatient physical therapy or speech pathology services. APPENDIX-Addenda for Several States Incorporating Conditions of Participation Higher Than Those Imposed by the Health Insurance for the Aged Program. Subpart M-Conditions for Coverage of 405.1514 Reconsidered determination. 405.1515 Submission of evidence. 405.1516 Notice of reconsidered determination. 405.1517 Effect of reconsidered determination. 405.1518 Extension of time to request re consideration. 405.1519 Revision of initial or reconsidered determinations. 405.1520 Notice of revision. 405.1521 Effect of reused determination. 405.1559 Removal of hearing to the Appeals Council. 405.1560 Remand by the Administrative Law Judge. 405.1561 Right to request a review of Administrative Law Judge's decision or dismissal. 405.1562 Time and place of filing requests for review. 405.1563 Action by the Appeals Council on request for review. 405.1564 Procedures before the Appeals Council on review. 405.1565 Evidence admissible on review. 405.1566 Decision of the Appeals Council or remanding of case. 405.1567 Effect of the Appeals Council decision. 405.1568 Dismissal by Appeals Council. 405.1569 Extension of time to request a hearing or review or begin civil action. 405.1570 Reopening decisions of an Administrative Law Judge or the Appeals Council. 405.1571 Notice of revision. 405.1572 Effect of revised determination. Subpart P-Certification and Recertification; Claims and Benefit Payment Requirements; Check Replacement Procedures 405.1625 Certification and recertification by physicians; general. 405.1626 Inpatient hospital services other than inpatient psychiatric or tuberculosis hospital services; certification and recertification for services furnished prior to January 3, 1968. 405.1627 Inpatient hospital services other than inpatient psychiatric or tuberculosis hospital services; certification and recertification for services furnished on or after January 3, 1968. 405.1629 Inpatient tuberculosis hospital services and inpatient psychiatric hospital services; certification and recertification. 405.1630 Certification and recertification for beneficiary admitted to a hospital before entitlement to benefits. 405.1631 Outpatient hospital diagnostic services furnished prior to January 3, 1968; certification. 405.1632 Post-hospital extended care services; certification and recertification. 405.1633 Home health services; certification and recertification. 405.1634 Medical and other health services covered by the supplementary medical insurance program furnished by a provider of services; certification and recertification. 405.1660 Payment on behalf of the individual; general. 405.1662 Form used for claiming payment. 405.1663 Individual's request for payment. 405.1664 Persons authorized to request payment. 405.1665 Evidence of authority to execute a request for payment. 405.1666 Signature by representative of the participating provider or hospital. 405.1667 Claim for payment by a provider of services or a hospital which has elected to claim payment for emergency services or services outside the United States. 405.1672 Individual's request for direct payment-General. 405.1674 Individual's request for direct payment; evidence describing services. 405.1675 Assignment of right to receive payment under the supplementary medical insurance benefits plan. 405.1678 Direct payment or assignment of payment; prescribed form. 405.1679 Execution of claim for payment. 405.1680 Payment of assigned benefits. 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-compliance with Federal, State, and local laws. 405.1716 Condition of participation-administrative management. 405.1717 Condition of participation-physician's direction and plan of care. 405.1718 Condition of participation-phys Sec. 405.1722 Condition of participation-clinical records. 405.1723 Condition of participation-physical environment. 405.1724 Condition of participation-infec tion control. 405.1725 Condition of participation-disaster preparedness. 405.1726 Condition of participation-program evaluation. CONDITIONS FOR COVERAGE: OUTPATIENT PHYSICAL THERAPY SERVICES FURNISHED BY PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE 405.1730 Conditions for coverage-Services furnished by physical therapists in independent practice-General. 405.1731 Definitions relating to physical therapists in independent practice. 405.1732 Condition for coverage-compli ance with Federal, State, and local laws. 405.1733 Condition for coverage-physician's direction and plan of care. 405.1734 Condition for coverage-physical therapy services. 405.1735 Condition for coverage-coordination of services with other organizations, agencies, or individuals. 405.1736 Condition for coverage-clinical records. 405.1737 Condition for coverage-physical environment. Subpart R-Provider Reimbursement 405.1801 Introduction. 405.1803 Intermediary determination and notice of amount of program reimbursement. 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. |