An MA organization may not pay, directly or indirectly, on any basis, for services (other than emergency or urgently needed services as defined in Sec. 422.2) furnished to a Medicare enrollee by a physician (as defined in section 1861(r)(1) of the Act) or other practitioner (as defined in section 1842(b)(18)(C) of the Act) who has filed with the Medicare carrier an affidavit promising to furnish Medicare-covered services to Medicare beneficiaries only through private contracts under section 1802(b) of the Act with the beneficiaries. An MA organization must pay for emergency or urgently needed services furnished by a physician or practitioner who has not signed a private contract with the beneficiary. Subpart F_Submission of Bids, Premiums, and Related Information and Plan
Approval
Source: 70 FR 4725, Jan. 28, 2005, unless otherwise noted.