Medicare as secondary payer and Medicare recovery against third parties--HCFA. Final rule.
These rules-- 1. Update and revise policies dealing with Medicare as secondary payer; 2. Revise policy on the exclusion of services of immediate relatives of the beneficiary or members of the beneficiary's household; 3. Revise policy on the exclusion of services furnished outside the United States; 4. Clarify policy on the "no legal obligation to pay" exclusion as it applies to services furnished to prisoners; and 5. Reflect a recent statutory amendment that provides an additional exception to the exclusion of services that are "not reasonable and necessary". The changes in the Medicare secondary payer provisions reflect amendments made to section 1862(b) of the Social Security Act (the Act) by section 2344 of the Deficit Reduction Act of 1984 (Pub. L. 98-369), section 9201 of the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. 99-272), and section 4036(a) of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203). Separate regulations will be issued to implement section 9319 of the Omnibus Budget Reconciliation Act of 1986 (Pub. L. 99-509), which made Medicare secondary payer for certain disabled Medicare beneficiaries under age 65 who are covered under a large group health plan.
D014487:Centers for Medicare and Medicaid Services, U.S.; D003669:Deductibles and Coinsurance / Q000331:legislation & jurisprudence*; D007341:Insurance / Q000331:legislation & jurisprudence*; D007344:Insurance Claim Reporting / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence*; D014481:United States