Fed Regist. 1997 Oct 29;62(209 Pt 1):56106-11.
This final rule makes two changes to Medicare's provider agreement regulations concerning payment for inpatient hospital services furnished to retired enrollees of fee-for-service Federal Employee Health Benefits (FEHB) plans who do not have Medicare Part A coverage. The first change specifies that payment for inpatient hospital services furnished to retired Federal workers age 65 or older who are enrolled in a fee-for-service FEHB plan but are not covered under Medicare Part A is limited to a payment amount that approximates the Medicare diagnosis-related group payment rates established under Medicare's inpatient hospital prospective payment system. The second change specifies that HCFA will consider termination or nonrenewal of a hospital's provider agreement with Medicare if a hospital knowingly and willfully fails to accept, on a repeated basis, the Medicare rate as payment in full for inpatient hospital services provided to a retired Federal worker who is enrolled in a fee-for-service FEHB plan and who does not have Medicare Part A coverage. This final rule implements section 7002(f) of the Omnibus Budget Reconciliation Act of 1990.
本最终规则对医疗保险的提供者协议规定做出了两项修改，涉及向未参加医疗保险A部分的按服务收费的联邦雇员健康福利（FEHB）计划退休参保人提供住院医院服务的支付问题。第一项修改规定，向65岁及以上、参加按服务收费的FEHB计划但未纳入医疗保险A部分的退休联邦工作人员提供住院医院服务的支付金额，限于近似医疗保险住院医院预期支付系统规定的医疗保险诊断相关组支付率的金额。第二项修改规定，如果医院明知且故意多次拒绝接受将医疗保险费率作为向参加按服务收费的FEHB计划且未参加医疗保险A部分的退休联邦工作人员提供住院医院服务的全额支付，则医疗保险和医疗补助服务中心（HCFA）将考虑终止或不续签该医院与医疗保险的提供者协议。本最终规则实施了1990年《综合预算协调法》第7002(f)条。
