Sec. 303. Use of private contracts
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/bill/115/s/1804/is/section-303·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Subject to the provisions of this subsection, nothing in this Act shall prohibit an institutional or individual provider from entering into a private contract with an enrolled individual for any item or service— for which no claim for payment is to be submitted under this Act, and for which the provider receives— no reimbursement under this Act directly or on a capitated basis, and receives no amount for such item or service from an organization which receives reimbursement for such items or service under this Act directly or on a capitated basis. Subsection
(a)shall not apply to any contract unless— the contract is in writing and is signed by the beneficiary before any item or service is provided pursuant to the contract; the contract contains the items described in paragraph (2); and the contract is not entered into at a time when the beneficiary is facing an emergency health care situation. Any contract to provide items and services to which subsection
(a)applies shall clearly indicate to the beneficiary that by signing such contract the beneficiary— agrees not to submit a claim (or to request that the provider submit a claim) under this Act for such items or services even if such items or services are otherwise covered by this Act; agrees to be responsible, whether through insurance offered under section 107(b) or otherwise, for payment of such items or services and understands that no reimbursement will be provided under this Act for such items or services; acknowledges that no limits under this Act apply to amounts that may be charged for such items or services; if the provider is a non-participating provider, acknowledges that the beneficiary has the right to have such items or services provided by other providers for whom payment would be made under this Act; and acknowledges that the provider is providing services outside the scope of the program under this Act. Subsection
(a)shall not apply to any contract unless an affidavit described in paragraph
(2)is in effect during the period any item or service is to be provided pursuant to the contract. An affidavit is described in this subparagraph shall— identify the practitioner, and be signed by such practitioner; provide that the practitioner will not submit any claim under this title for any item or service provided to any beneficiary (and will not receive any reimbursement or amount described in paragraph (1)(B) for any such item or service) during the 1-year period beginning on the date the affidavit is signed; and be filed with the Secretary no later than 10 days after the first contract to which such affidavit applies is entered into. If a physician or practitioner signing an affidavit described in paragraph
(2)knowingly and willfully submits a claim under this title for any item or service provided during the 1-year period described in paragraph (2)(B) (or receives any reimbursement or amount described in subsection (a)(2) for any such item or service) with respect to such affidavit— this subsection shall not apply with respect to any items and services provided by the physician or practitioner pursuant to any contract on and after the date of such submission and before the end of such period; and no payment shall be made under this title for any item or service furnished by the physician or practitioner during the period described in clause
(i)(and no reimbursement or payment of any amount described in subsection (a)(2) shall be made for any such item or service).