Special rules for Medicare+Choice private fee-for-service plans
For purposes of applying this part (including subsection (k)(1)) and section 1395cc(a)(1)(O) of this title , a hospital (or other provider of services), a physician or other health care professional, or other entity furnishing health care services is treated as having an agreement or contract in effect with a Medicare+Choice organization (with respect to an individual enrolled in a Medicare+Choice private fee-for-service plan it offers), if—
(A)#
the provider, professional, or other entity furnishes services that are covered under the plan to such an enrollee; and
(B)#
before providing such services, the provider, professional, or other entity—
(i) has been informed of the individual’s enrollment under the plan, and
(ii) either— (I) has been informed of the terms and conditions of payment for such services under the plan, or (II) is given a reasonable opportunity to obtain information concerning such terms and conditions,
in a manner reasonably designed to effect informed agreement by a provider.
(B)(i)#
has been informed of the individual’s enrollment under the plan, and
(B)(ii)#
either—
(I) has been informed of the terms and conditions of payment for such services under the plan, or
(II) is given a reasonable opportunity to obtain information concerning such terms and conditions,
(B)(ii)(I)#
has been informed of the terms and conditions of payment for such services under the plan, or