Medicare FFS definition

Medicare FFS means Medicare Part A and Part B. As used in this Agreement, the term Medicare FFS does not include Medicare Part C (Medicare Advantage) or Medicare Part D (Prescription Drug Benefit).
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Examples of Medicare FFS in a sentence

  • The State’s Medicare FFS beneficiaries must not experience any reductions in their rights to benefits or covered services under this Agreement.

  • If after the start of a PY, the State wishes to update a Participant Hospital’s Medicare FFS Hospital Global Budget for that PY, the State must submit a written request to CMS describing and providing its rationale for the requested update(s), as well as a proposed implementation timeline for each update.

  • If the State does not meet the Medicare FFS Primary Care Investment Target in any two PYs within a period of three consecutive PYs, CMS will issue a Warning Notice and may issue an Enforcement Action Notice, in a form and manner as described in Section 20.

  • CMS may request additional information or data as needed to validate the State’s calculations of any Participant Hospital’s Medicare FFS Hospital Global Budget.

  • If CMS identifies an error in the State’s calculation of any Participant Hospital’s Medicare FFS Hospital Global Budget, the State must correct any such errors at least 60 days prior to the start of the applicable PY.

  • The State may calculate the Medicare FFS Hospital Global Budget for each Participant Hospital in a given PY if the State notifies CMS at least 365 days in advance of the applicable PY that it will do so.

  • The Parties acknowledge that as of January 1, 2025, CMS did not receive such notification from the State and CMS will calculate the Medicare FFS Hospital Global Budget for each Participant Hospital in PY1.

  • If the State submits such notification to CMS for PY2 or subsequent PYs, the State must submit to CMS each Participant Hospital’s Medicare FFS Hospital Global Budget, as calculated by the State using the CMS-Approved State- Designed Medicare FFS Hospital Global Budget Methodology for the upcoming Performance Year, no later than 150 days prior to the start of that Performance Year.

  • Within 30 days of CMS' receipt of each Participant Hospital’s Medicare FFS Global Budget as calculated by the State, CMS will review and validate each Participant Hospital’s Medicare FFS Hospital Global Budget and notify the State of its decision to approve payment of the Medicare FFS Hospital Global Budget for a Participant Hospital as submitted or require revisions.

  • If CMS does not approve a Participant Hospital’s Medicare FFS Hospital Global Budget at least 60 days prior to the start of the applicable PY, CMS will calculate the Medicare FFS Hospital Global Budget for the Participant Hospital using the CMS-Approved State-Designed Medicare FFS Hospital Global Budget Methodology.

Related to Medicare FFS

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.

  • Health care facility or "facility" means hospices licensed

  • Child care facility or “facility” means a child care center, a preschool, or a registered child development home.

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Group care facility means an agency, other than a foster-family home, which is maintained and operated for the care of a group of children on a 24 hour basis. RCW 74.15.020

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Health care coverage means any plan providing hospital, medical or surgical care coverage for

  • Health Care Laws means: (i) the Federal Food, Drug, and Cosmetic Act (21 U.S.C. §§ 301 et seq.), the Public Health Service Act (42 U.S.C. §§ 201 et seq.), and the regulations promulgated thereunder; (ii) all applicable federal, state, local and all applicable foreign health care related fraud and abuse laws, including, without limitation, the U.S. Anti-Kickback Statute (42 U.S.C. Section 1320a-7b(b)), the U.S. Physician Payment Sunshine Act (42 U.S.C. § 1320a-7h), the U.S. Civil False Claims Act (31 U.S.C. Section 3729 et seq.), the criminal False Claims Law (42 U.S.C. § 1320a-7b(a)), all criminal laws relating to health care fraud and abuse, including but not limited to 18 U.S.C. Sections 286 and 287, and the health care fraud criminal provisions under the U.S. Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) (42 U.S.C. Section 1320d et seq.), the exclusion laws (42 U.S.C. § 1320a-7), the civil monetary penalties law (42 U.S.C. § 1320a-7a), HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act (42 U.S.C. Section 17921 et seq.), and the regulations promulgated pursuant to such statutes; (iii) Medicare (Title XVIII of the Social Security Act); (iv) Medicaid (Title XIX of the Social Security Act); (v) the Controlled Substances Act (21 U.S.C. §§ 801 et seq.) and the regulations promulgated thereunder; and (vi) any and all other applicable health care laws and regulations. Neither the Company nor, to the knowledge of the Company, any subsidiary has received notice of any claim, action, suit, proceeding, hearing, enforcement, investigation, arbitration or other action from any court or arbitrator or governmental or regulatory authority or third party alleging that any product operation or activity is in material violation of any Health Care Laws, and, to the Company’s knowledge, no such claim, action, suit, proceeding, hearing, enforcement, investigation, arbitration or other action is threatened. Neither the Company nor, to the knowledge of the Company, any subsidiary is a party to or has any ongoing reporting obligations pursuant to any corporate integrity agreements, deferred prosecution agreements, monitoring agreements, consent decrees, settlement orders, plans of correction or similar agreements with or imposed by any governmental or regulatory authority. Additionally, neither the Company, its Subsidiaries nor any of its respective employees, officers or directors has been excluded, suspended or debarred from participation in any U.S. federal health care program or human clinical research or, to the knowledge of the Company, is subject to a governmental inquiry, investigation, proceeding, or other similar action that could reasonably be expected to result in debarment, suspension, or exclusion.