TITLE 42 - PUBLIC HEALTH

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER A - GENERAL PROVISIONS

PART 403 - SPECIAL PROGRAMS AND PROJECTS

subpart g - RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS - BENEFITS, CONDITIONS OF PARTICIPATION, AND PAYMENT

403.752 - Payment provisions.

  (a) Payment to RNHCIs. Payment for services may be made to an RNHCI that meets the conditions for coverage described in 403.720 and the conditions of participation described in 403.730 through 403.746.

Payment is made in accordance with 413.40 of this chapter to an RNHCI meeting these conditions.

  (b) Review of estimates and adjustments. There is no administrative or judicial review of the level of estimated expenditures or the adjustments in payments described in 403.750(a) and (b).

  (c) Effect on beneficiary liability. When payments are reduced in accordance with 403.750(b), the RNHCI may bill the beneficiary the amount of the Medicare reduction attributable to his or her covered services.

  (d) Notification of beneficiary liability. (1) The RNHCI must notify the beneficiary in writing at the time of admission of any proposed or current proportional Medicare adjustment. A beneficiary currently receiving care in the RNHCI must be notified in writing at least 30 days before the Medicare reduction is to take effect. The notification must inform the beneficiary that the RNHCI can bill him or her for the proportional Medicare adjustment.

  (2) The RNHCI must, at time of billing, provide the beneficiary with his or her liability for payment, based on a calculation of the Medicare reduction pertaining to the beneficiary's covered services permitted by 403.750(b).