C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 489—PROVIDER AGREEMENTS AND SUPPLIER APPROVAL › Subpart A—General Provisions

42 C.F.R. § 489.3

Definitions

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For purposes of this part—

Immediate jeopardy means a situation in which the provider's or supplier's non-compliance with one or more requirements, conditions of participation, conditions for coverage, or conditions for certification has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident or patient.

Physician-owned hospital means any participating hospital (as defined in § 489.24) in which a physician, or an immediate family member of a physician (as defined in § 411.351 of this chapter), has an ownership or investment interest in the hospital. The ownership or investment interest may be through equity, debt, or other means, and includes an interest in an entity that holds an ownership or investment interest in the hospital. This definition does not include a hospital with physician ownership or investment interests that satisfy the requirements at § 411.356(a) or (b) of this chapter.

Provider agreement means an agreement between CMS and one of the providers specified in § 489.2(b) to provide services to Medicare beneficiaries and to comply with the requirements of section 1866 of the Act.

[48 FR 39837, Sept. 1, 1983, as amended at 51 FR 24492, July 3, 1986; 54 FR 5373, Feb. 2, 1989; 59 FR 56250, Nov. 10, 1994; 60 FR 50119, Sept. 28, 1995; 72 FR 47412, Aug. 22, 2007; 73 FR 48757, Aug. 19, 2008; 80 FR 29840, May 22, 2015]
Notes of Decisions
Cited in 2 cases, 2015–2020 · leading case: Anna Jacques Hosp. v. Sylvia Mathews Burwell, 797 F.3d 1155 (D.C. Cir. 2015).
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Anna Jacques Hosp. v. Sylvia Mathews Burwell, 797 F.3d 1155 (D.C. Cir. 2015). “, through which they may bill for services provided to Medicare beneficiaries as long as they comply with all program requirements, 42 C.F.R. § 489.3 . Multi-campus hospitals’ subordinate campuses have “provider-based” status that entitles them to operate under the multi-campus…”
United States of Am. v. Procarent, Inc. (S.D. Ind. 2020). “§ 1395cc; 42 C.F.R. § 489.3 . Generally, an assignment is an agreement by the health care provider to be paid directly by Medicare, to accept the amount Medicare approves for the service, and not to bill the patient for any more than the Medicare deductible and co- insurance.”
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