Part 405 Federal Health Insurance for the Aged and Disabled
Part 406 Hospital Insurance Eligibility and Entitlement
Part 407 Supplementary Medical Insurance (Smi) Enrollment and Entitlement
Part 408 Premiums for Supplementary Medical Insurance
Part 409 Hospital Insurance Benefits
Part 410 Supplementary Medical Insurance (Smi) Benefits
Part 411 Exclusions From Medicare and Limitations On Medicare Payment
Part 412 Prospective Payment Systems for Inpatient Hospital Services
Part 413 Principles of Reasonable Cost Reimbursement; Payment for End-Stage Renal Disease Services; Prospectively Determined Payment Rates for Skilled Nursing Facilities; Payment for Acute Kidney Injury Dialysis
Part 414 Payment for Part B Medical and Other Health Services
Part 415 Services Furnished by Physicians in Providers, Supervising Physicians in Teaching Settings, and Residents in Certain Settings
Part 416 Ambulatory Surgical Services
Part 417 Health Maintenance Organizations, Competitive Medical Plans, and Health Care Prepayment Plans
Part 418 Hospice Care
Part 419 Prospective Payment System for Hospital Outpatient Department Services
Part 420 Program Integrity: Medicare
Part 421 Medicare Contracting
Part 422 Medicare Advantage Program
Part 423 Voluntary Medicare Prescription Drug Benefit
Part 424 Conditions for Medicare Payment
Part 425 Medicare Shared Savings Program
Part 426 Review of National Coverage Determinations and Local Coverage Determinations

Terms Used In CFR > Title 42 > Chapter IV > Subchapter B

  • Accounting basis: The cost data submitted must be based on the accrual basis of accounting which is recognized as the most accurate basis for determining costs. See 42 CFR 413.24
  • accrual basis of accounting: means that revenue is reported in the period in which it is earned, regardless of when it is collected. See 42 CFR 413.24
  • ACO participant: means an entity identified by a Medicare-enrolled billing TIN through which one or more ACO providers/suppliers bill Medicare, that alone or together with one or more other ACO participants compose an ACO, and that is included on the list of ACO participants that is required under §425. See 42 CFR 425.20
  • ACO participant agreement: means the written agreement (as required at §425. See 42 CFR 425.20
  • ACO professional: means an individual who is Medicare-enrolled and bills for items and services furnished to Medicare fee-for-service beneficiaries under a Medicare billing number assigned to the TIN of an ACO participant in accordance with applicable Medicare regulations and who is either of the following:

    (1) A physician legally authorized to practice medicine and surgery by the State in which he or she performs such function or action. See 42 CFR 425.20

  • act: means the Investment Company Act of 1940. See 17 CFR 270.0-1
  • Actual cost: means the negotiated price for a covered Part D drug when the drug is purchased at a network pharmacy, and the usual and customary price when a beneficiary purchases the drug at an out-of-network pharmacy consistent with §423. See 42 CFR 423.100
  • Actual costs: means the subset of prescription drug costs (not including administrative costs or return on investment, but including costs directly related to the dispensing of covered Part D drugs during the year) that are attributable to standard benefits only and that are incurred and actually paid by the sponsor or organization under the plan. See 42 CFR 423.855
  • Actuarial factors: means factors such as the age, sex, and disability level distribution of the population and any other relevant factors that CMS determines have a significant effect on the level of utilization and cost of health services. See 42 CFR 417.582
  • Adjourn: A motion to adjourn a legislative chamber or a committee, if passed, ends that day's session.
  • administrator: means any person who provides significant administrative or business affairs management services to an investment company. See 17 CFR 270.0-1
  • Administrator: means the Administrator or Deputy Administrator of CMS. See 42 CFR 405.1801
  • Administrator review: means that review provided for in section 1878(f) of the Act (42 U. See 42 CFR 405.1801
  • Advanced market risk-weighted assets: means the advanced measure for market risk calculated under §324. See 12 CFR 324.2
  • Affected enrollee: means a Part D enrollee who is currently taking a covered Part D drug that is either being removed from a Part D plan's formulary, or whose preferred or tiered cost-sharing status is changing and such drug removal or cost-sharing change affects the Part D enrollee's access to the drug during the current plan year. See 42 CFR 423.100
  • Affected party: means an MA organization impacted by an initial determination or if applicable, by any subsequent determination or decision issued under this part. See 42 CFR 422.1002
  • Affected party: means any Part D sponsor or manufacturer (as defined in §423. See 42 CFR 423.1002
  • Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
  • Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
  • Agent: means any person who has been delegated the authority to obligate or act on behalf of a provider. See 42 CFR 420.201
  • Agreement: means a collective bargaining agreement. See 42 CFR 417.150
  • Agreement period: means the term of the participation agreement. See 42 CFR 425.20
  • Aligned enrollment: refers to the enrollment in a dual eligible special needs plan of full-benefit dual eligible individuals whose Medicaid benefits are covered under a Medicaid managed care organization contract under section 1903(m) of the Act between the applicable State and: the dual eligible special needs plan's (D-SNP's) MA organization, the D-SNP's parent organization, or another entity that is owned and controlled by the D-SNP's parent organization. See 42 CFR 422.2
  • ALJ: includes a member or members of the Departmental Appeals Board who are designated to conduct a hearing. See 42 CFR 422.1024
  • ALJ: includes a member or members of the Departmental Appeals Board who are designated to conduct a hearing. See 42 CFR 423.1024
  • Allocated transfer risk reserves: means reserves that have been established in accordance with section 905(a) of the International Lending Supervision Act, against certain assets whose value U. See 12 CFR 324.2
  • Allowable costs: means costs that are incurred by a RHC or FQHC that is authorized to bill based on reasonable costs and are reasonable in amount and proper and necessary for the efficient delivery of RHC and FQHC services. See 42 CFR 405.2401
  • Alternative prescription drug coverage: means coverage of Part D drugs, other than standard prescription drug coverage that meets the requirements of §423. See 42 CFR 423.100
  • Alternative prescription drug coverage: means coverage of Part D drugs, other than standard prescription drug coverage that meets the requirements of §423. See 42 CFR 423.100
  • Amortization: Paying off a loan by regular installments.
  • Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
  • Appeal: means any of the procedures that deal with the review of adverse organization determinations on the health care services the enrollee believes he or she is entitled to receive, including delay in providing, arranging for, or approving the health care services (such that a delay would adversely affect the health of the enrollee), or on any amounts the enrollee must pay for a service, as defined under §422. See 42 CFR 422.561
  • Appeal: means any of the procedures that deal with the review of adverse coverage determinations made by the Part D plan sponsor on the benefits under a Part D plan the enrollee believes he or she is entitled to receive, including delay in providing or approving the drug coverage (when a delay would adversely affect the health of the enrollee), or on any amounts the enrollee must pay for the drug coverage, as defined in §423. See 42 CFR 423.560
  • Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
  • Applicable beneficiary: means an individual who, on the date of dispensing a covered Part D drug--

    (1) Is enrolled in a prescription drug plan or an MA-PD plan. See 42 CFR 423.100

  • Applicable discount: means 50 percent of the portion of the negotiated price (as defined in §423. See 42 CFR 423.2305
  • Applicable drug: means a Part D drug that is--

    (1)(i) Approved under a new drug application under section 505(b) of the Federal Food, Drug, and Cosmetic Act (FDCA). See 42 CFR 423.100

  • Applicant: means one who submits an application, request, or plan required to be approved by the Water Resources Council, or by a primary recipient, as a condition to eligibility for Federal financial assistance, and the term application means such an application, request, or plan. See 18 CFR 705.2
  • Appointed representative: means an individual either appointed by an enrollee or authorized under State or other applicable law to act on behalf of the enrollee in filing a grievance, obtaining a coverage determination, or in dealing with any of the levels of the appeals process. See 42 CFR 423.560
  • Appraisal: A determination of property value.
  • Arrangement: means a written agreement between an MA organization and a provider or provider network, under which--

    (1) The provider or provider network agrees to furnish for a specific MA plan(s) specified services to the organization's MA enrollees. See 42 CFR 422.2

  • Arrangements: means arrangements which provide that Medicare payment made to the provider that arranged for the services discharges the liability of the beneficiary or any other person to pay for those services. See 42 CFR 409.3
  • Arrest: Taking physical custody of a person by lawful authority.
  • ASC: means any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission. See 42 CFR 416.2
  • Assessment reference date: means the specific calendar day in the patient assessment process that sets the designated endpoint of the common patient observation period, with most patient assessment items usually referring back in time from this endpoint. See 42 CFR 412.602
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Assignable beneficiary: means a Medicare fee-for-service beneficiary who receives at least one primary care service with a date of service during a specified 12-month assignment window from a Medicare-enrolled physician who is a primary care physician or who has one of the specialty designations included in §425. See 42 CFR 425.20
  • Assignment: means the operational process by which CMS determines whether a beneficiary has chosen to receive a sufficient level of the requisite primary care services from ACO professionals so that the ACO may be appropriately designated as exercising basic responsibility for that beneficiary's care during a given benchmark or performance year. See 42 CFR 425.20
  • Assignment window: means the 12-month period used to assign beneficiaries to an ACO. See 42 CFR 425.20
  • At-risk beneficiary: means a Part D eligible individual--

    (1) Who is--

    (i) Identified using clinical guidelines (as defined in this section). See 42 CFR 423.100

  • At-risk beneficiary: means a Part D eligible individual--

    (1) Who is--

    (i) Identified using clinical guidelines (as defined in this section). See 42 CFR 423.100

  • At-risk determination: means a decision made under a plan sponsor's drug management program in accordance with §423. See 42 CFR 423.560
  • Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
  • Authorized official: means an appointed official (for example, chief executive officer, chief financial officer, general partner, chairman of the board, or direct owner) to whom the organization has granted the legal authority to enroll it in the Medicare program, to make changes or updates to the organization's status in the Medicare program, and to commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program. See 42 CFR 424.502
  • Backtesting: means the comparison of an FDIC-supervised institution's internal estimates with actual outcomes during a sample period not used in model development. See 12 CFR 324.101
  • Backtesting: means the comparison of an FDIC-supervised institution's internal estimates with actual outcomes during a sample period not used in model development. See 12 CFR 324.202
  • Balanced budget: A budget in which receipts equal outlays.
  • Bank: means an FDIC-insured, state-chartered commercial or savings bank that is not a member of the Federal Reserve System and for which the FDIC is the appropriate Federal banking agency pursuant to section 3(q) of the Federal Deposit Insurance Act (12 U. See 12 CFR 324.2
  • Bank holding company: means a bank holding company as defined in section 2 of the Bank Holding Company Act. See 12 CFR 324.2
  • Bank Holding Company Act: means the Bank Holding Company Act of 1956, as amended (12 U. See 12 CFR 324.2
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Bargaining representative: means an individual or entity designated or selected, under any applicable Federal, State, or local law, or public entity collective bargaining agreement, to represent employees in collective bargaining, or any other employee representative designated or selected under any law. See 42 CFR 417.150
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • Basic benefits: means all Medicare-covered benefits (except hospice services). See 42 CFR 422.2
  • Basic prescription drug coverage: means coverage of Part D drugs that is either standard prescription drug coverage or basic alternative coverage. See 42 CFR 423.100
  • Basic prescription drug coverage: means coverage of Part D drugs that is either standard prescription drug coverage or basic alternative coverage. See 42 CFR 423.100
  • Basis derivative contract: means a non-foreign-exchange derivative contract (i. See 12 CFR 324.2
  • Benchmarking: means the comparison of an FDIC-supervised institution's internal estimates with relevant internal and external data or with estimates based on other estimation techniques. See 12 CFR 324.101
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Beneficiary: means an individual enrolled in the Supplementary Medical Insurance program for the Aged and Disabled (part of title XVIII of the Act). See 42 CFR 405.2401
  • Benefits: means health care services that are intended to maintain or improve the health status of enrollees, for which the MA organization incurs a cost or liability under an MA plan (not solely an administrative processing cost). See 42 CFR 422.2
  • Bequest: Property gifted by will.
  • Bid: means an offer to furnish a CAP drug within a category of CAP drugs in a competitive acquisition area for a particular price and time period. See 42 CFR 414.902
  • Bioequivalent: has the meaning given such term in section 505(j)(8) of the Food, Drug, and Cosmetic Act. See 42 CFR 423.100
  • Bioequivalent: has the meaning given such term in section 505(j)(8) of the Food, Drug, and Cosmetic Act. See 42 CFR 423.100
  • Biosimilar biological product: means a biological product approved under an abbreviated application for a license of a biological product that relies in part on data or information in an application for another biological product licensed under section 351 of the Public Health Service Act (PHSA) as defined at section 1847A(c)(6)(H) of the Act. See 42 CFR 414.902
  • Board: means the Provider Reimbursement Review Board established in accordance with section 1878 of the Act (42 U. See 42 CFR 405.1801
  • Board hearing: means that hearing provided for in section 1878(a) of the Act (42 U. See 42 CFR 405.1801
  • Bond option contract: means a bond option, bond future, or any other instrument linked to a bond that gives rise to similar counterparty credit risk. See 12 CFR 324.101
  • Business environment and internal control factors: means the indicators of an FDIC-supervised institution's operational risk profile that reflect a current and forward-looking assessment of the FDIC-supervised institution's underlying business risk factors and internal control environment. See 12 CFR 324.101
  • Call Report: means Consolidated Reports of Condition and Income. See 12 CFR 324.2
  • CAP drug: means a physician-administered drug or biological furnished on or after January 1, 2006 described in section 1842(o)(1)(C) of the Act and supplied by an approved CAP vendor under the CAP as provided in this subpart. See 42 CFR 414.902
  • Capitation payment: means a fixed per enrollee per month amount paid for contracted services without regard to the type, cost, or frequency of services furnished. See 42 CFR 422.350
  • Carrier: means a voluntary association, corporation, partnership, or other organization that is engaged in providing, paying for, or reimbursing all or part of the cost of health benefits under group insurance policies or contracts, medical or hospital service agreements, enrollment or subscription contracts, or similar group arrangements, in consideration of premiums or other periodic charges payable to the carrier. See 42 CFR 417.150
  • Centralized building: means all or part of a building, including, for purposes of this subpart only, a mobile vehicle, van, or trailer that is owned or leased on a full-time basis (that is, 24 hours per day, 7 days per week, for a term of not less than 6 months) by a group practice and that is used exclusively by the group practice. See 42 CFR 411.351
  • CFTC: means the U. See 12 CFR 324.2
  • Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
  • Clean-up call: means a contractual provision that permits an originating FDIC-supervised institution or servicer to call securitization exposures before their stated maturity or call date. See 12 CFR 324.2
  • Cleared transaction: means an exposure associated with an outstanding derivative contract or repo-style transaction that an FDIC-supervised institution or clearing member has entered into with a central counterparty (that is, a transaction that a central counterparty has accepted). See 12 CFR 324.2
  • Clearing member: means a member of, or direct participant in, a CCP that is entitled to enter into transactions with the CCP. See 12 CFR 324.2
  • Clearing member client: means a party to a cleared transaction associated with a CCP in which a clearing member acts either as a financial intermediary with respect to the party or guarantees the performance of the party to the CCP. See 12 CFR 324.2
  • Client-facing derivative transaction: means a derivative contract that is not a cleared transaction where the FDIC-supervised institution is either acting as a financial intermediary and enters into an offsetting transaction with a qualifying central counterparty (QCCP) or where the FDIC-supervised institution provides a guarantee to the QCCP on the performance of a client on a transaction between the client and a QCCP. See 12 CFR 324.2
  • Clinical laboratory services: means the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings, including procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body, as specifically identified by the List of CPT/HCPCS Codes. See 42 CFR 411.351
  • CMS reviewing official: means the reviewing official provided for in §405. See 42 CFR 405.1801
  • CMS reviewing official procedure: means the review provided for in §405. See 42 CFR 405.1801
  • Coinsurance: is a fixed percentage of the total amount paid for a health care service that can be charged to an MA enrollee on a per-service basis. See 42 CFR 422.2
  • Coinsurance: means that portion of the RHC's charge for covered services or that portion of the FQHC's charge or PPS rate for covered services for which the beneficiary is liable (in addition to the deductible, where applicable). See 42 CFR 405.2401
  • Collateral agreement: means a legal contract that specifies the time when, and circumstances under which, a counterparty is required to pledge collateral to an FDIC-supervised institution for a single financial contract or for all financial contracts in a netting set and confers upon the FDIC-supervised institution a perfected, first-priority security interest (notwithstanding the prior security interest of any custodial agent), or the legal equivalent thereof, in the collateral posted by the counterparty under the agreement. See 12 CFR 324.2
  • Collective bargaining agreement: means an agreement entered into between an employing entity and the bargaining representative of its employees. See 42 CFR 417.150
  • Commercial end-user: means an entity that:

    (1)(i) Is using derivative contracts to hedge or mitigate commercial risk. See 12 CFR 324.2

  • Commission: means the Securities and Exchange Commission. See 17 CFR 270.0-1
  • Commitment: means any legally binding arrangement that obligates an FDIC-supervised institution to extend credit or to purchase assets. See 12 CFR 324.2
  • Commodity derivative contract: means a commodity-linked swap, purchased commodity-linked option, forward commodity-linked contract, or any other instrument linked to commodities that gives rise to similar counterparty credit risks. See 12 CFR 324.2
  • Commodity Exchange Act: means the Commodity Exchange Act of 1936 (7 U. See 12 CFR 324.2
  • Commodity position: means a position for which price risk arises from changes in the price of a commodity. See 12 CFR 324.202
  • Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
  • Communication materials: means all information provided to current and prospective enrollees. See 42 CFR 422.2260
  • Communication materials: means all information provided to current and prospective enrollees. See 42 CFR 423.2260
  • Community rating system: means a system of fixing rates of payments for health services that meets the requirements of §417. See 42 CFR 417.1
  • Comorbidity: means a specific patient condition that is secondary to the patient's principal diagnosis that is the primary reason for the inpatient rehabilitation stay. See 42 CFR 412.602
  • Company: means a corporation, partnership, limited liability company, depository institution, business trust, special purpose entity, association, or similar organization. See 12 CFR 324.2
  • Competitive acquisition area: means a geographic area established by the Secretary for purposes of implementing the CAP required by section 1847B of the Act. See 42 CFR 414.902
  • Comprehensive health services: means as a minimum the following services which may be limited as to time and cost:

    (1) Physician services (§417. See 42 CFR 417.1

  • Consultation: means a professional service furnished to a patient by a physician if the following conditions are satisfied:

    (1) The physician's opinion or advice regarding evaluation or management or both of a specific medical problem is requested by another physician. See 42 CFR 411.351

  • Continuance: Putting off of a hearing ot trial until a later time.
  • Contract: means an employer-employee or public entity-employee contract, or a contract for health benefits. See 42 CFR 417.150
  • Contracted pharmacy network: means licensed pharmacies, including retail, mail-order, and institutional pharmacies under contract with a Part D sponsor to provide covered Part D drugs at negotiated prices to Part D enrollees. See 42 CFR 423.100
  • Contractor determination: means the following:

    (1) With respect to a provider of services that has filed a cost report under §§413. See 42 CFR 405.1801

  • Contractor hearing: means that hearing provided for in §405. See 42 CFR 405.1801
  • Contractors: refers to Medicare Administrative Contractors and other entities that contract with CMS to review and adjudicate claims for Medicare payment of items and services. See 42 CFR 405.201
  • Control: A person or company controls a company if it:

    (1) Owns, controls, or holds with power to vote 25 percent or more of a class of voting securities of the company. See 12 CFR 324.2

  • Control: means that an individual, group of individuals, or entity has the power, directly or indirectly, to direct or influence significantly the actions or policies of an organization or institution. See 42 CFR 422.350
  • Conviction: A judgement of guilt against a criminal defendant.
  • Copayment: is a fixed amount that can be charged to an MA plan enrollee on a per-service basis. See 42 CFR 422.2
  • Core capital: means Tier 1 capital, as defined in §324. See 12 CFR 324.2
  • Corporate debt position: means a debt position that is an exposure to a company that is not a sovereign entity, the Bank for International Settlements, the European Central Bank, the European Commission, the International Monetary Fund, the European Stability Mechanism, the European Financial Stability Facility, a multilateral development bank, a depository institution, a foreign bank, a credit union, a public sector entity, a GSE, or a securitization. See 12 CFR 324.202
  • Cost contract: means a Medicare contract under which CMS pays the HMO or CMP on a reasonable cost basis. See 42 CFR 417.401
  • Cost finding: Cost finding is the process of recasting the data derived from the accounts ordinarily kept by a provider to ascertain costs of the various types of services furnished. See 42 CFR 413.24
  • Cost reports: For cost reporting purposes, the Medicare program requires each provider of services to submit periodic reports of its operations that generally cover a consecutive 12-month period of the provider's operations. See 42 CFR 413.24
  • Cost-sharing: includes deductibles, coinsurance, and copayments. See 42 CFR 422.2
  • Coverage gap: means the period in prescription drug coverage that occurs between the initial coverage limit and the out-of-pocket threshold. See 42 CFR 423.100
  • Coverage gap: means the period in prescription drug coverage that occurs between the initial coverage limit and the out-of-pocket threshold. See 42 CFR 423.100
  • Covered: refers to services for which the law and the regulations authorize Medicare payment. See 42 CFR 409.3
  • Covered ancillary services: means items and services that are integral to a covered surgical procedure performed in an ASC as provided in §416. See 42 CFR 416.2
  • Covered Part B services: means physicians' services, diagnostic X-ray tests, laboratory, other diagnostic tests, and any additional medical and other health services, that the HCPP furnishes to its Medicare enrollees. See 42 CFR 417.800
  • Covered position: means the following positions:

    (1) A trading asset or trading liability (whether on- or off-balance sheet),32 as reported on Call Report, that meets the following conditions:

    32Securities subject to repurchase and lending agreements are included as if they are still owned by the lender. See 12 CFR 324.202

  • Covered services: means items or services for which the beneficiary is entitled to have payment made on his or her behalf under this subpart. See 42 CFR 405.2401
  • Covered surgical procedures: means those surgical procedures furnished before January 1, 2008, that meet the criteria specified in §416. See 42 CFR 416.2
  • Credit derivative: means a financial contract executed under standard industry credit derivative documentation that allows one party (the protection purchaser) to transfer the credit risk of one or more exposures (reference exposure(s)) to another party (the protection provider) for a certain period of time. See 12 CFR 324.2
  • Credit risk mitigant: means collateral, a credit derivative, or a guarantee. See 12 CFR 324.2
  • Credit Score: A number, roughly between 300 and 800, that measures an individual's credit worthiness. The most well-known type of credit score is the FICO score. This score represents the answer from a mathematical formula that assigns numerical values to various pieces of information in your credit report. Source: OCC
  • Credit union: means an insured credit union as defined under the Federal Credit Union Act (12 U. See 12 CFR 324.2
  • Credit-enhancing representations and warranties: means representations and warranties that are made or assumed in connection with a transfer of underlying exposures (including loan servicing assets) and that obligate an FDIC-supervised institution to protect another party from losses arising from the credit risk of the underlying exposures. See 12 CFR 324.2
  • Credit-risk-weighted assets: means 1. See 12 CFR 324.2
  • Current employment status: has the meaning given this term in §411. See 42 CFR 406.24
  • Current exposure methodology: means the method of calculating the exposure amount for over-the-counter derivative contracts in §324. See 12 CFR 324.2
  • Current ratio: means total current assets divided by total current liabilities. See 42 CFR 422.350
  • Custodian: means a financial institution that has legal custody of collateral provided to a CCP. See 12 CFR 324.2
  • Custody bank: means an FDIC-supervised institution that is a subsidiary of a depository institution holding company that is a custodial banking organization under 12 CFR 217. See 12 CFR 324.2
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Date of dispensing: means the date of service. See 42 CFR 423.2305
  • Date of receipt: means the date a document or other material is received by either of the following:

    (1) A party or an affected nonparty. See 42 CFR 405.1801

  • Days: means calendar days. See 42 CFR 411.101
  • Deactivate: means that the provider or supplier's billing privileges were stopped, but can be restored upon the submission of updated information. See 42 CFR 424.502
  • Debt position: means a covered position that is not a securitization position or a correlation trading position and that has a value that reacts primarily to changes in interest rates or credit spreads. See 12 CFR 324.202
  • Deductible: means the amount incurred by the beneficiary during a calendar year as specified in §410. See 42 CFR 405.2401
  • Deed: The legal instrument used to transfer title in real property from one person to another.
  • Default fund contribution: means the funds contributed or commitments made by a clearing member to a CCP's mutualized loss sharing arrangement. See 12 CFR 324.2
  • Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
  • Definitions: See §415. See 42 CFR 415.200
  • Delegated official: means an individual who is delegated by the "Authorized Official" the authority to report changes and updates to the enrollment record. See 42 CFR 424.502
  • Demonstration project: means a demonstration project under section 402 of the Social Security Amendments of 1967 (42 U. See 42 CFR 417.401
  • Dependence: means a measure of the association among operational losses across and within units of measure. See 12 CFR 324.101
  • Dependent: A person dependent for support upon another.
  • Deposition: An oral statement made before an officer authorized by law to administer oaths. Such statements are often taken to examine potential witnesses, to obtain discovery, or to be used later in trial.
  • Depository institution: means a depository institution as defined in section 3 of the Federal Deposit Insurance Act. See 12 CFR 324.2
  • Depository institution holding company: means a bank holding company or savings and loan holding company. See 12 CFR 324.2
  • Derivative contract: means a financial contract whose value is derived from the values of one or more underlying assets, reference rates, or indices of asset values or reference rates. See 12 CFR 324.2
  • Designated carrier: means an entity assigned by CMS to process and pay claims for drugs and biologicals under the CAP. See 42 CFR 414.902
  • Designee: means any person or entity authorized to act on behalf of an employing entity or a group of employing entities to offer the option of enrollment in a qualified health maintenance organization to their eligible employees. See 42 CFR 417.150
  • Direct medical and surgical services: means services to individual beneficiaries that are either personally furnished by a physician or furnished by a resident under the supervision of a physician in a teaching hospital making the cost election described in §§415. See 42 CFR 415.152
  • Discharge: A Medicare patient in a long-term care hospital is considered discharged when--

    (1) For purposes of the long-term care hospital qualification calculation, as described in §412. See 42 CFR 412.503

  • Discharge: A Medicare patient in an inpatient rehabilitation facility is considered discharged when--

    (1) The patient is formally released from the inpatient rehabilitation facility. See 42 CFR 412.602

  • Discretionary bonus payment: means a payment made to an executive officer of an FDIC-supervised institution, where:

    (1) The FDIC-supervised institution retains discretion as to whether to make, and the amount of, the payment until the payment is awarded to the executive officer. See 12 CFR 324.2

  • Dispensing fees: means costs that-

    (1) Are incurred at the point of sale and pay for costs in excess of the ingredient cost of a covered Part D drug each time a covered Part D drug is dispensed. See 42 CFR 423.100

  • Dispensing fees: means costs that-

    (1) Are incurred at the point of sale and pay for costs in excess of the ingredient cost of a covered Part D drug each time a covered Part D drug is dispensed. See 42 CFR 423.100

  • disposal agency: as used in this part refers to GSA. See 41 CFR 102-75.5
  • Dodd-Frank Act: means the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010 (Pub. See 12 CFR 324.2
  • Donee: The recipient of a gift.
  • Donor: The person who makes a gift.
  • double-apportionment method: The double-apportionment method may be used by a provider upon approval of the contractor. See 42 CFR 413.24
  • Downstream contractor: means a "first tier contractor" as defined at §1001. See 42 CFR 411.351
  • Drug: refers to both drugs and biologicals. See 42 CFR 414.704
  • Drug: means both drugs and biologicals. See 42 CFR 414.802
  • Drug: means both drugs and biologicals. See 42 CFR 414.902
  • Early amortization provision: means a provision in the documentation governing a securitization that, when triggered, causes investors in the securitization exposures to be repaid before the original stated maturity of the securitization exposures, unless the provision:

    (1) Is triggered solely by events not directly related to the performance of the underlying exposures or the originating FDIC-supervised institution (such as material changes in tax laws or regulations). See 12 CFR 324.2

  • Effective notional amount: means for an eligible guarantee or eligible credit derivative, the lesser of the contractual notional amount of the credit risk mitigant and the exposure amount (or EAD for purposes of subpart E of this part) of the hedged exposure, multiplied by the percentage coverage of the credit risk mitigant. See 12 CFR 324.2
  • Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
  • Electronic health record: means a repository of consumer health status information in computer processable form used for clinical diagnosis and treatment for a broad array of clinical conditions. See 42 CFR 411.351
  • Eligible ABCP liquidity facility: means a liquidity facility supporting ABCP, in form or in substance, that is subject to an asset quality test at the time of draw that precludes funding against assets that are 90 days or more past due or in default. See 12 CFR 324.2
  • Eligible clean-up call: means a clean-up call that:

    (1) Is exercisable solely at the discretion of the originating FDIC-supervised institution or servicer. See 12 CFR 324.2

  • Eligible credit derivative: means a credit derivative in the form of a credit default swap, nth-to-default swap, total return swap, or any other form of credit derivative approved by the FDIC, provided that:

    (1) The contract meets the requirements of an eligible guarantee and has been confirmed by the protection purchaser and the protection provider. See 12 CFR 324.2

  • Eligible employee: means an employee who meets the employer's requirements for participation in the health benefits plan. See 42 CFR 417.150
  • Eligible guarantee: means a guarantee that:

    (1) Is written. See 12 CFR 324.2

  • Eligible operational risk offsets: means amounts, not to exceed expected operational loss, that:

    (1) Are generated by internal business practices to absorb highly predictable and reasonably stable operational losses, including reserves calculated consistent with GAAP. See 12 CFR 324.101

  • Eligible servicer cash advance facility: means a servicer cash advance facility in which:

    (1) The servicer is entitled to full reimbursement of advances, except that a servicer may be obligated to make non-reimbursable advances for a particular underlying exposure if any such advance is contractually limited to an insignificant amount of the outstanding principal balance of that exposure. See 12 CFR 324.2

  • Embezzlement: In most states, embezzlement is defined as theft/larceny of assets (money or property) by a person in a position of trust or responsibility over those assets. Embezzlement typically occurs in the employment and corporate settings. Source: OCC
  • Emergency delivery: means delivery of a CAP drug within one business day in appropriate shipping and packaging, in all areas of the United States and its territories, with the exception of the Pacific Territories. See 42 CFR 414.902
  • Emergency response: means responding immediately at the BLS or ALS1 level of service to a 911 call or the equivalent in areas without a 911 call system. See 42 CFR 414.605
  • Emergency services: means covered inpatient or outpatient services that are furnished by an appropriate source other than the HMO or CMP and that meet the following conditions:

    (1) Are needed immediately because of an injury or sudden illness. See 42 CFR 417.401

  • Emergency services: means inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health and, because of the danger to life or health, require use of the most accessible hospital available and equipped to furnish those services. See 42 CFR 424.101
  • Employee: means any individual employed by an employer or public entity on a full-time or part-time basis. See 42 CFR 417.150
  • Employee: means any individual who, under the common law rules that apply in determining the employer-employee relationship (as applied for purposes of section 3121(d)(2) of the Internal Revenue Code of 1986), is considered to be employed by, or an employee of, an entity. See 42 CFR 405.2401
  • Employee: means any individual who, under the common law rules that apply in determining the employer-employee relationship (as applied for purposes of section 3121(d)(2) of the Internal Revenue Code of 1986), is considered to be employed by, or an employee of, an entity. See 42 CFR 411.351
  • Employer: has the meaning given that term in section 3(d) of the Fair Labor Standards Act of 1938, except that it--

    (1) Includes non-appropriated fund instrumentalities of the United States Government. See 42 CFR 417.150

  • Employing entity: means an employer or public entity. See 42 CFR 417.150
  • Encode: means entering data items into the fields of the computerized patient assessment software program. See 42 CFR 412.602
  • Encounter: means a direct personal contact between a patient and a physician, or other person who is authorized by State licensure law and, if applicable, by hospital or CAH staff bylaws, to order or furnish hospital services for diagnosis or treatment of the patient. See 42 CFR 410.2
  • Enrollee: means an individual who is enrolled in the SMI program under Medicare Part B. See 42 CFR 408.3
  • Enrollee: means an MA eligible individual who has elected an MA plan offered by an MA organization. See 42 CFR 422.561
  • Enrollee: means an individual for whom an HMO, CMP, or HCPP assumes the responsibility, under a contract or agreement, for the furnishing of health care services on a prepaid basis. See 42 CFR 417.1
  • Enrollee: means a Part D eligible individual who has elected or has been enrolled in a Part D plan. See 42 CFR 423.560
  • Enrollment application: means a CMS-approved paper enrollment application or an electronic Medicare enrollment process approved by OMB. See 42 CFR 424.502
  • Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
  • Entity: means a person, group, or facility that is enrolled in the Medicare program. See 42 CFR 424.71
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • Equity derivative contract: means an equity-linked swap, purchased equity-linked option, forward equity-linked contract, or any other instrument linked to equities that gives rise to similar counterparty credit risks. See 12 CFR 324.2
  • Equity position: means a covered position that is not a securitization position or a correlation trading position and that has a value that reacts primarily to changes in equity prices. See 12 CFR 324.202
  • ERISA: means the Employee Retirement Income and Security Act of 1974 (29 U. See 12 CFR 324.2
  • Escrow: Money given to a third party to be held for payment until certain conditions are met.
  • et seq: and 12 CFR part 1805. See 12 CFR 324.2
  • Event risk: means the risk of loss on equity or hybrid equity positions as a result of a financial event, such as the announcement or occurrence of a company merger, acquisition, spin-off, or dissolution. See 12 CFR 324.202
  • Exception: A QCCP that fails to meet the requirements of a QCCP in the future may still be treated as a QCCP under the conditions specified in §324. See 12 CFR 324.2
  • Exchange rate derivative contract: means a cross-currency interest rate swap, forward foreign-exchange contract, currency option purchased, or any other instrument linked to exchange rates that gives rise to similar counterparty credit risks. See 12 CFR 324.2
  • Executive officer: means a person who holds the title or, without regard to title, salary, or compensation, performs the function of one or more of the following positions: president, chief executive officer, executive chairman, chief operating officer, chief financial officer, chief investment officer, chief legal officer, chief lending officer, chief risk officer, or head of a major business line, and other staff that the board of directors of the FDIC-supervised institution deems to have equivalent responsibility. See 12 CFR 324.2
  • Executor: A male person named in a will to carry out the decedent
  • Exempted beneficiary: means with respect to a drug management program, an enrollee who--

    (1) Has elected to receive hospice care or is receiving palliative or end-of-life care. See 42 CFR 423.100

  • Exempted beneficiary: means with respect to a drug management program, an enrollee who--

    (1) Has elected to receive hospice care or is receiving palliative or end-of-life care. See 42 CFR 423.100

  • Exposure category: means any of the wholesale, retail, securitization, or equity exposure categories. See 12 CFR 324.101
  • Facility: includes all or any part of structures, equipment, or other real or personal property or interests therein, and the provision of facilities includes the construction, expansion, renovation, remodeling, alteration or acquisition of facilities. See 18 CFR 705.2
  • Facility: means a hospital or other institution that furnishes health care services to inpatients. See 42 CFR 424.71
  • Facility services: means for the period before January 1, 2008, services that are furnished in connection with covered surgical procedures performed in an ASC, and beginning January 1, 2008, means services that are furnished in connection with covered surgical procedures performed in an ASC as provided in §416. See 42 CFR 416.2
  • fair market value: means the value of rental property for general commercial purposes (not taking into account its intended use). See 42 CFR 411.351
  • fallback entity: means an entity that, for a particular contract period-

    (1) Is a PDP sponsor that does not have to be a risk-bearing entity (or, if applying to become a fallback entity, an entity that meets all the requirements to become a Part D plan sponsor except that it does not have to be a risk-bearing entity). See 42 CFR 423.855

  • Fallback prescription drug plan: means a prescription drug plan (PDP) offered by a fallback entity that--

    (1) Offers only defined standard or actuarially equivalent standard prescription drug coverage as defined in §423. See 42 CFR 423.855

  • Family member: has the meaning given this term in §411. See 42 CFR 406.24
  • Family member: means a person who is enrolled in an LGHP based on another person's enrollment. See 42 CFR 411.201
  • FDIC-supervised institution: means any bank or state savings association. See 12 CFR 324.2
  • Federal Deposit Insurance Act: means the Federal Deposit Insurance Act (12 U. See 12 CFR 324.2
  • Federal Deposit Insurance Corporation: A government corporation that insures the deposits of all national and state banks that are members of the Federal Reserve System. Source: OCC
  • Federal Deposit Insurance Corporation Improvement Act: means the Federal Deposit Insurance Corporation Improvement Act of 1991 (Pub. See 12 CFR 324.2
  • Federal per diem base rate: means the payment based on the average routine operating, ancillary, and capital-related cost of 1 day of hospital inpatient services in an inpatient psychiatric facility. See 42 CFR 412.402
  • Federal per diem payment amount: means the Federal per diem base rate with all applicable adjustments. See 42 CFR 412.402
  • Federal Reserve: means the Board of Governors of the Federal Reserve System. See 12 CFR 324.2
  • Federal Reserve System: The central bank of the United States. The Fed, as it is commonly called, regulates the U.S. monetary and financial system. The Federal Reserve System is composed of a central governmental agency in Washington, D.C. (the Board of Governors) and twelve regional Federal Reserve Banks in major cities throughout the United States. Source: OCC
  • Felony: A crime carrying a penalty of more than a year in prison.
  • Fiduciary: A trustee, executor, or administrator.
  • Final adverse action: means one or more of the following actions:

    (1) A Medicare-imposed revocation of any Medicare billing privileges. See 42 CFR 424.502

  • Finance charge: The total cost of credit a customer must pay on a consumer loan, including interest. The Truth in Lending Act requires disclosure of the finance charge. Source: OCC
  • Financial collateral: means collateral:

    (1) In the form of:

    (i) Cash on deposit with the FDIC-supervised institution (including cash held for the FDIC-supervised institution by a third-party custodian or trustee). See 12 CFR 324.2

  • First tier entity: means any party that enters into a written arrangement, acceptable to CMS, with an MA organization or applicant to provide administrative services or health care services for a Medicare eligible individual under the MA program. See 42 CFR 422.2
  • First-lien residential mortgage exposure: means a residential mortgage exposure secured by a first lien. See 12 CFR 324.2
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Fiscally sound operation: means an operation which at least maintains a positive net worth (total assets exceed total liabilities). See 42 CFR 422.2
  • Fixed dollar loss threshold amount: means a dollar amount which, when added to the Federal payment amount for a case, the estimated costs of a case must exceed in order for the case to qualify for an outlier payment. See 42 CFR 412.402
  • Fixed Rate: Having a "fixed" rate means that the APR doesn't change based on fluctuations of some external rate (such as the "Prime Rate"). In other words, a fixed rate is a rate that is not a variable rate. A fixed APR can change over time, in several circumstances:
    • You are late making a payment or commit some other default, triggering an increase to a penalty rate
    • The bank changes the terms of your account and you do not reject the change.
    • The rate expires (if the rate was fixed for only a certain period of time).
  • Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. Source: OCC
  • Foreign bank: means a foreign bank as defined in §211. See 12 CFR 324.2
  • Forward agreement: means a legally binding contractual obligation to purchase assets with certain drawdown at a specified future date, not including commitments to make residential mortgage loans or forward foreign exchange contracts. See 12 CFR 324.2
  • Full-time student: means a student who is enrolled for a sufficient number of credit hours in a semester or other academic term to enable the student to complete the course of study within not more than the number of semesters or other academic terms normally required to complete that course of study on a full-time basis at the school in which the student is enrolled. See 42 CFR 417.1
  • Fully integrated dual eligible special needs plan: means a dual eligible special needs plan--

    (1) That provides dual eligible individuals access to Medicare and Medicaid benefits under a single entity that holds both an MA contract with CMS and a Medicaid managed care organization contract under section 1903(m) of the Act with the applicable State. See 42 CFR 422.2

  • Functional-related groups: refers to the distinct groups under which inpatients are classified using proxy measurements of inpatient rehabilitation relative resource usage. See 42 CFR 412.602
  • Fund governance standards: The board of directors of an investment company ("fund") satisfies the fund governance standards if:

    (i) At least seventy-five percent of the directors of the fund are not interested persons of the fund ("disinterested directors") or, if the fund has three directors, all but one are disinterested directors. See 17 CFR 270.0-1

  • GAAP: means generally accepted accounting principles as used in the United States. See 12 CFR 324.2
  • Gain-on-sale: means an increase in the equity capital of an FDIC-supervised institution (as reported on Schedule RC of the Call Report) resulting from a traditional securitization (other than an increase in equity capital resulting from the FDIC-supervised institution's receipt of cash in connection with the securitization or reporting of a mortgage servicing asset on Schedule RC of the Call Report. See 12 CFR 324.2
  • Garnishment: Generally, garnishment is a court proceeding in which a creditor asks a court to order a third party who owes money to the debtor or otherwise holds assets belonging to the debtor to turn over to the creditor any of the debtor
  • General market risk: means the risk of loss that could result from broad market movements, such as changes in the general level of interest rates, credit spreads, equity prices, foreign exchange rates, or commodity prices. See 12 CFR 324.202
  • General market value: means the price that an asset would bring as the result of bona fide bargaining between well-informed buyers and sellers who are not otherwise in a position to generate business for the other party, or the compensation that would be included in a service agreement as the result of bona fide bargaining between well-informed parties to the agreement who are not otherwise in a position to generate business for the other party, on the date of acquisition of the asset or at the time of the service agreement. See 42 CFR 411.351
  • General obligation: means a bond or similar obligation that is backed by the full faith and credit of a public sector entity (PSE). See 12 CFR 324.2
  • Geographic area: means the area found by CMS to be the area within which the HMO or CMP furnishes, or arranges for furnishing, the full range of services that it offers to its Medicare enrollees. See 42 CFR 417.401
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • Government-funded health program: means any program established, maintained, or funded, in whole or in part, by the Government of the United States, by the government of any State or political subdivision of a State, or by any agency or instrumentality of any of the foregoing, which uses public funds, in whole or in part, to provide to, or pay on behalf of, an individual the cost of Part D drugs, including any of the following:

    (1) An approved State child health plan under title XXI of the Act providing benefits for child health assistance that meets the requirements of section 2103 of the Act. See 42 CFR 423.100

  • Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
  • Grantor: The person who establishes a trust and places property into it.
  • Grievance: means any complaint or dispute, other than one that constitutes an organization determination, expressing dissatisfaction with any aspect of an MA organization's or provider's operations, activities, or behavior, regardless of whether remedial action is requested. See 42 CFR 422.561
  • Grievance: means any complaint or dispute, other than one that involves a coverage determination or at-risk determination, expressing dissatisfaction with any aspect of the operations, activities, or behavior of a Part D plan sponsor, regardless of whether remedial action is requested. See 42 CFR 423.560
  • Ground ambulance organization: means a Medicare provider or supplier of ground ambulance services. See 42 CFR 414.605
  • Group enrollment period: means the period of at least 10 working days each calendar year during which each eligible employee is given the opportunity to select among the alternatives included in a health benefits plan. See 42 CFR 417.150
  • Guarantee: means a financial guarantee, letter of credit, insurance, or other similar financial instrument (other than a credit derivative) that allows one party (beneficiary) to transfer the credit risk of one or more specific exposures (reference exposure) to another party (protection provider). See 12 CFR 324.2
  • Guarantor: A party who agrees to be responsible for the payment of another party's debts should that party default. Source: OCC
  • Guarantor: means an entity that--

    (1) Has been approved by CMS as meeting the requirements to be a guarantor. See 42 CFR 422.350

  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Health benefits plan: means any arrangement, to provide or pay for health services, that is offered to eligible employees, or to eligible employees and their eligible dependents, by or on behalf of an employing entity. See 42 CFR 417.150
  • Health professionals: means physicians (doctors of medicine and doctors of osteopathy), dentists, nurses, podiatrists, optometrists, physicians' assistants, clinical psychologists, social workers, pharmacists, nutritionists, occupational therapists, physical therapists, and other professionals engaged in the delivery of health services who are licensed, practice under an institutional license, are certified, or practice under authority of the HMO, a medical group, individual practice association, or other authority consistent with State law. See 42 CFR 417.1
  • Hedge: means a position or positions that offset all, or substantially all, of one or more material risk factors of another position. See 12 CFR 324.202
  • Highly integrated dual eligible special needs plan: means a dual eligible special needs plan offered by an MA organization that provides coverage, consistent with State policy, of long-term services and supports, behavioral health services, or both, under a capitated contract that meets one of the following arrangements--

    (1) The capitated contract is between the MA organization and the Medicaid agency. See 42 CFR 422.2

  • Home country: means the country where an entity is incorporated, chartered, or similarly established. See 12 CFR 324.2
  • Home health services: means the services described in section 1861(m) of the Act and part 409, subpart E of this chapter. See 42 CFR 411.351
  • Hospital: means any entity that qualifies as a "hospital" under section 1861(e) of the Act, as a "psychiatric hospital" under section 1861(f) of the Act, or as a "critical access hospital" under section 1861(mm)(1) of the Act, and refers to any separate legally organized operating entity plus any subsidiary, related entity, or other entities that perform services for the hospital's patients and for which the hospital bills. See 42 CFR 411.351
  • Hospital: means a facility that--

    (1) Is primarily engaged in providing, by or under the supervision of doctors of medicine or osteopathy, inpatient services for the diagnosis, treatment, and care or rehabilitation of persons who are sick, injured, or disabled. See 42 CFR 424.101

  • Hospital: means a hospital as defined in section 1886(d)(1)(B) of the Act. See 42 CFR 425.20
  • HRSA: means the Health Resources and Services Administration. See 42 CFR 405.2401
  • Idiosyncratic risk: means the risk of loss in the value of a position that arises from changes in risk factors unique to that position. See 12 CFR 324.202
  • incident to: means those services and supplies that meet the requirements of section 1861(s)(2)(A) of the Act, §410. See 42 CFR 411.351
  • Incremental risk: means the default risk and credit migration risk of a position. See 12 CFR 324.202
  • Incurred costs: means costs incurred by a Part D enrollee for--

    (1)(i) Covered Part D drugs that are not paid for under the Part D plan as a result of application of any annual deductible or other cost-sharing rules for covered Part D drugs prior to the Part D enrollee satisfying the out-of-pocket threshold under §423. See 42 CFR 423.100

  • Incurred costs: means costs incurred by a Part D enrollee for--

    (1)(i) Covered Part D drugs that are not paid for under the Part D plan as a result of application of any annual deductible or other cost-sharing rules for covered Part D drugs prior to the Part D enrollee satisfying the out-of-pocket threshold under §423. See 42 CFR 423.100

  • Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. Source: FDIC
  • Independent collateral: means financial collateral, other than variation margin, that is subject to a collateral agreement, or in which a FDIC-supervised institution has a perfected, first-priority security interest or, outside of the United States, the legal equivalent thereof (with the exception of cash on deposit. See 12 CFR 324.2
  • Indirect exposure: means an exposure that arises from the FDIC-supervised institution's investment in an investment fund which holds an investment in the FDIC-supervised institution's own capital instrument or an investment in the capital of an unconsolidated financial institution. See 12 CFR 324.2
  • Indirect ownership interest: means any ownership interest in an entity that has an ownership interest in the disclosing entity. See 42 CFR 420.201
  • Initial costs of operation: means any cost incurred in the first 60 months of an operation or expansion that met any of the following requirements:

    (1) Under generally accepted accounting principles or under accounting practices prescribed or permitted by State regulatory authority, was not a capital cost. See 42 CFR 417.911

  • Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
  • Inpatient psychiatric facilities: means hospitals that meet the requirements as specified in §§412. See 42 CFR 412.402
  • Insolvency: means a condition in which the liabilities of the debtor exceed the fair valuation of its assets. See 42 CFR 422.350
  • Institutional provider: means any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (not including physician and nonphysician practitioner organizations), CMS-855S, CMS-20134, or an associated Internet-based PECOS enrollment application. See 42 CFR 424.502
  • Institutionalized: means for the purpose of defining a special needs individual, an MA eligible individual who continuously resides or is expected to continuously reside for 90 days or longer in a long-term care facility which is a skilled nursing facility (SNF) nursing facility (NF). See 42 CFR 422.2
  • Insurance: means a health plan that provides, or pays the cost of Part D drugs, including, but not limited to, any of the following:

    (1) Health insurance coverage (as defined in 42 U. See 42 CFR 423.100

  • Insurance: means a health plan that provides, or pays the cost of Part D drugs, including, but not limited to, any of the following:

    (1) Health insurance coverage (as defined in 42 U. See 42 CFR 423.100

  • Insurance company: means an insurance company as defined in section 201 of the Dodd-Frank Act (12 U. See 12 CFR 324.2
  • Insurance underwriting company: means an insurance company as defined in section 201 of the Dodd-Frank Act (12 U. See 12 CFR 324.2
  • Insured depository institution: means an insured depository institution as defined in section 3 of the Federal Deposit Insurance Act. See 12 CFR 324.2
  • Integrated grievance: means a dispute or complaint that would be defined and covered, for grievances filed by an enrollee in non-applicable integrated plans, under §422. See 42 CFR 422.561
  • Integrated organization determination: means an organization determination that would otherwise be defined and covered, for a non-applicable integrated plan, as an organization determination under §422. See 42 CFR 422.561
  • Integrated reconsideration: means a reconsideration that would otherwise be defined and covered, for a non-applicable integrated plan, as a reconsideration under §422. See 42 CFR 422.561
  • Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. Source: OCC
  • Interest rate derivative contract: means a single-currency interest rate swap, basis swap, forward rate agreement, purchased interest rate option, when-issued securities, or any other instrument linked to interest rates that gives rise to similar counterparty credit risks. See 12 CFR 324.2
  • Intermediary: means an entity that has a contract with CMS (under statutory provisions in effect prior to October 1, 2005) to determine and make Medicare payments for Part A or Part B benefits payable on a cost basis (or under the prospective payment system for hospitals) and to perform other related functions. See 42 CFR 421.3
  • International Lending Supervision Act: means the International Lending Supervision Act of 1983 (12 U. See 12 CFR 324.2
  • Interoperable: means able to communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks, in various settings. See 42 CFR 411.351
  • Interrupted stay: means a stay at an inpatient rehabilitation facility during which a Medicare inpatient is discharged from the inpatient rehabilitation facility and returns to the same inpatient rehabilitation facility within 3 consecutive calendar days. See 42 CFR 412.602
  • Investment Company Act: means the Investment Company Act of 1940 (15 U. See 12 CFR 324.2
  • Investment fund: means a company:

    (1) Where all or substantially all of the assets of the company are financial assets. See 12 CFR 324.2

  • Investment grade: means that the entity to which the FDIC-supervised institution is exposed through a loan or security, or the reference entity with respect to a credit derivative, has adequate capacity to meet financial commitments for the projected life of the asset or exposure. See 12 CFR 324.2
  • Investment in the capital of an unconsolidated financial institution: means a net long position calculated in accordance with §324. See 12 CFR 324.2
  • Irrevocable trust: A trust arrangement that cannot be revoked, rescinded, or repealed by the grantor.
  • Junior-lien residential mortgage exposure: means a residential mortgage exposure that is not a first-lien residential mortgage exposure. See 12 CFR 324.2
  • Labeler code: means the first segment of the Food and Drug Administration national drug code (NDC) that identifies a particular manufacturer. See 42 CFR 423.2305
  • Laboratory: means an entity furnishing biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings. See 42 CFR 411.351
  • Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
  • Legacy: A gift of property made by will.
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • List of hospital outpatient department services requiring prior authorization: means the list of hospital outpatient department services described in §419. See 42 CFR 419.81
  • Local carrier: means an entity assigned by CMS to process and pay claims for administration of drugs and biologicals under the CAP. See 42 CFR 414.902
  • Long-term care facility: means a skilled nursing facility as defined in section 1819(a) of the Act, or a medical institution or nursing facility for which payment is made for an institutionalized individual under section 1902(q)(1)(B) of the Act. See 42 CFR 423.100
  • Long-term care facility: means a skilled nursing facility as defined in section 1819(a) of the Act, or a medical institution or nursing facility for which payment is made for an institutionalized individual under section 1902(q)(1)(B) of the Act. See 42 CFR 423.100
  • Long-term care hospital prospective payment system payment year: means the general term that encompasses both the definition of "long-term care hospital prospective payment system rate year" and "long-term care hospital prospective payment system fiscal year" specified in this section. See 42 CFR 412.503
  • Long-term care network pharmacy: means a long-term care pharmacy that is a network pharmacy. See 42 CFR 423.100
  • Long-term care pharmacy: means a pharmacy owned by or under contract with a long-term care facility to provide prescription drugs to the facility's residents. See 42 CFR 423.100
  • MA eligible individual: means an individual who meets the requirements of §422. See 42 CFR 422.2
  • MA local plan: means an MA plan that is not an MA regional plan. See 42 CFR 422.2
  • MA organization: has the meaning given the term in 422. See 42 CFR 422.1002
  • MA organization: means a public or private entity organized and licensed by a State as a risk-bearing entity (with the exception of provider-sponsored organizations receiving waivers) that is certified by CMS as meeting the MA contract requirements. See 42 CFR 422.2
  • MA plan: means health benefits coverage offered under a policy or contract by an MA organization that includes a specific set of health benefits offered at a uniform premium and uniform level of cost-sharing to all Medicare beneficiaries residing in the service area of the MA plan (or in individual segments of a service area, under §422. See 42 CFR 422.2
  • MA plan enrollee: is an MA eligible individual who has elected an MA plan offered by an MA organization. See 42 CFR 422.2
  • MA regional plan: means a coordinated care plan structured as a preferred provider organization (PPO) that serves one or more entire regions. See 42 CFR 422.2
  • Main index: means the Standard & Poor's 500 Index, the FTSE All-World Index, and any other index for which the FDIC-supervised institution can demonstrate to the satisfaction of the FDIC that the equities represented in the index have comparable liquidity, depth of market, and size of bid-ask spreads as equities in the Standard & Poor's 500 Index and FTSE All-World Index. See 12 CFR 324.2
  • Major surgical procedure: means a surgical procedure for which a 10-day or 90-day global period is used for payment under the physician fee schedule and section 1848(b) of the Act. See 42 CFR 414.2
  • Managing employee: means a general manager, business manager, administrator, director, or other individual that exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operation of the institution, organization, or agency, either under contract or through some other arrangement, whether or not the individual is a W-2 employee. See 42 CFR 420.201
  • Managing employee: means a general manager, business manager, administrator, director, or other individual that exercises operational or managerial control over, or who directly or indirectly conducts, the day-to-day operation of the provider or supplier, either under contract or through some other arrangement, whether or not the individual is a W-2 employee of the provider or supplier. See 42 CFR 424.502
  • Mandatory supplemental benefits: means health care services not covered by Medicare that an MA enrollee must accept or purchase as part of an MA plan. See 42 CFR 422.2
  • Manufacturer: means any entity which is engaged in the production, preparation, propagation, compounding, conversion or processing of prescription drug products, either directly or indirectly, by extraction from substances of natural origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis. See 42 CFR 423.2305
  • Manufacturer: means any entity that is engaged in the following (This term does not include a wholesale distributor of drugs or a retail pharmacy licensed under State law):

    (1) Production, preparation, propagation, compounding, conversion or processing of prescription drug products, either directly or indirectly by extraction from substances of natural origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis. See 42 CFR 414.802

  • Market basket index: means an index that reflects changes over time in the prices of an appropriate mix of goods and services included in covered skilled nursing services. See 42 CFR 413.333
  • Market risk: means the risk of loss on a position that could result from movements in market prices. See 12 CFR 324.202
  • Market risk FDIC-supervised institution: means an FDIC-supervised institution that is described in §324. See 12 CFR 324.2
  • Markup: The process by which congressional committees and subcommittees debate, amend, and rewrite proposed legislation.
  • Medical group: means a partnership, association, corporation, or other group:

    (1) That is composed of health professionals licensed to practice medicine or osteopathy and of such other licensed health professionals (including dentists, optometrists, and podiatrists) as are necessary for the provision of health services for which the group is responsible. See 42 CFR 417.1

  • Medically underserved population: means the population of an urban or rural area as described in Sec. See 42 CFR 417.1
  • Medicare enrollee: means a beneficiary under Part B of Medicare who has been identified on CMS records as an enrollee of the HCPP. See 42 CFR 417.800
  • Medicare fee-for-service beneficiary: means an individual who is--

    (1) Enrolled in the original Medicare fee-for-service program under both parts A and B. See 42 CFR 425.20

  • Medicare Part D discount information: means the information sent from CMS or the TPA to the manufacturer along with each quarterly invoice that is derived from applicable data elements available on prescription drug events as determined by CMS. See 42 CFR 423.2305
  • Minimum transfer amount: means the smallest amount of variation margin that may be transferred between counterparties to a netting set pursuant to the variation margin agreement. See 12 CFR 324.2
  • Misdemeanor: Usually a petty offense, a less serious crime than a felony, punishable by less than a year of confinement.
  • Money market fund: means an investment fund that is subject to 17 CFR 270. See 12 CFR 324.2
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • MSA: means a Metropolitan Statistical Area, as defined by the Executive Office of Management and Budget. See 42 CFR 412.503
  • MSA-dominant hospital: means a hospital that has discharged more than 25 percent of the total subsection (d) hospital Medicare discharges in the MSA (not including discharges paid by a Medicare Advantage plan) in which the hospital is located. See 42 CFR 412.503
  • Multiple source drug: means a drug described by section 1847A(c)(6)(C) of the Act. See 42 CFR 414.902
  • National Bank: A bank that is subject to the supervision of the Comptroller of the Currency. The Office of the Comptroller of the Currency is a bureau of the U.S. Treasury Department. A national bank can be recognized because it must have "national" or "national association" in its name. Source: OCC
  • National Bank Act: means the National Bank Act (12 U. See 12 CFR 324.2
  • National Credit Union Administration: The federal regulatory agency that charters and supervises federal credit unions. (NCUA also administers the National Credit Union Share Insurance Fund, which insures the deposits of federal credit unions.) Source: OCC
  • Negotiated prices: means prices for covered Part D drugs that meet all of the following:

    (1) The Part D sponsor (or other intermediary contracting organization) and the network dispensing pharmacy or other network dispensing provider have negotiated as the amount such network entity will receive, in total, for a particular drug. See 42 CFR 423.100

  • Negotiated prices: means prices for covered Part D drugs that meet all of the following:

    (1) The Part D sponsor (or other intermediary contracting organization) and the network dispensing pharmacy or other network dispensing provider have negotiated as the amount such network entity will receive, in total, for a particular drug. See 42 CFR 423.100

  • Net independent collateral amount: means the fair value amount of the independent collateral, as adjusted by the standard supervisory haircuts under §324. See 12 CFR 324.2
  • Net worth: means the excess of total assets over total liabilities, excluding fully subordinated debt or subordinated liabilities. See 42 CFR 422.350
  • Netting set: means a group of transactions with a single counterparty that are subject to a qualifying master netting agreement. See 12 CFR 324.2
  • Network organization: The administrative governing body to the network and liaison to the Federal government. See 42 CFR 405.2102
  • Network pharmacy: means a licensed pharmacy that is under contract with a Part D sponsor to provide covered Part D drugs at negotiated prices to its Part D plan enrollees. See 42 CFR 423.100
  • Network pharmacy: means a licensed pharmacy that is under contract with a Part D sponsor to provide covered Part D drugs at negotiated prices to its Part D plan enrollees. See 42 CFR 423.100
  • Nominal charge provider: means a provider that furnishes services free of charge or at a nominal charge and is either a public provider, or another provider that (1) demonstrates to CMS's satisfaction that a significant portion of its patients are low-income, and (2) requests that payment for its services be determined accordingly. See 42 CFR 409.3
  • Non-preferred pharmacy: means a network pharmacy that offers covered Part D drugs at negotiated prices to Part D enrollees at higher cost-sharing levels than apply at a preferred pharmacy. See 42 CFR 423.100
  • Non-significant investment in the capital of an unconsolidated financial institution: means an investment by an advanced approaches FDIC-supervised institution in the capital of an unconsolidated financial institution where the advanced approaches FDIC-supervised institution owns 10 percent or less of the issued and outstanding common stock of the unconsolidated financial institution. See 12 CFR 324.2
  • Nonmetropolitan area: means an area no part of which is within a standard metropolitan statistical area as designated by the Office of Management and Budget and which does not contain a city whose population exceeds 50,000 individuals. See 42 CFR 417.1
  • nonparticipating: refers to a hospital, CAH, SNF, HHA, CORF, hospice, clinic, rehabilitation agency, public health agency, or CMHC that does not have in effect a provider agreement to participate in Medicare. See 42 CFR 410.2
  • Nonparticipating hospital: means a hospital that does not have in effect a provider agreement to participate in Medicare. See 42 CFR 424.3
  • Oath: A promise to tell the truth.
  • Obligor: means the legal entity or natural person contractually obligated on a wholesale exposure, except that an FDIC-supervised institution may treat the following exposures as having separate obligors:

    (1) Exposures to the same legal entity or natural person denominated in different currencies. See 12 CFR 324.101

  • OCC: means the Office of the Comptroller of the Currency, U. See 12 CFR 324.2
  • One-sided model: means a model under which the ACO may share savings with the Medicare program, if it meets the requirements for doing so, but is not liable for sharing any losses incurred under subpart G of this part. See 42 CFR 425.20
  • Operating entity: means a company established to conduct business with clients with the intention of earning a profit in its own right. See 12 CFR 324.2
  • Operational: means the provider or supplier has a qualified physical practice location, is open to the public for the purpose of providing health care related services, is prepared to submit valid Medicare claims, and is properly staffed, equipped, and stocked (as applicable, based on the type of facility or organization, provider or supplier specialty, or the services or items being rendered), to furnish these items or services. See 42 CFR 424.502
  • Operational loss: means a loss (excluding insurance or tax effects) resulting from an operational loss event. See 12 CFR 324.101
  • Operational loss event: means an event that results in loss and is associated with any of the following seven operational loss event type categories:

    (1) Internal fraud, which means the operational loss event type category that comprises operational losses resulting from an act involving at least one internal party of a type intended to defraud, misappropriate property, or circumvent regulations, the law, or company policy excluding diversity- and discrimination-type events. See 12 CFR 324.101

  • Operational risk: means the risk of loss resulting from inadequate or failed internal processes, people, and systems or from external events (including legal risk but excluding strategic and reputational risk). See 12 CFR 324.101
  • Operational risk exposure: means the 99. See 12 CFR 324.101
  • Or otherwise: means through a government-funded health program. See 42 CFR 423.100
  • Or otherwise: means through a government-funded health program. See 42 CFR 423.100
  • Oral argument: An opportunity for lawyers to summarize their position before the court and also to answer the judges' questions.
  • Original Medicare: means health insurance available under Medicare Part A and Part B through the traditional fee-for service payment system. See 42 CFR 422.2
  • Other disclosing entity: means any other Medicare disclosing entity and any entity that does not participate in Medicare, but is required to disclose certain ownership and control information because of participation in any of the programs established under title V, XIX, or XX of the Act. See 42 CFR 420.201
  • Other health or prescription drug coverage: means any coverage or financial assistance under other health benefit plans or programs that provide coverage or financial assistance for the purchase or provision of prescription drug coverage on behalf of applicable beneficiaries, including, in the case of employer group health or waiver plans, other than basic prescription drug coverage as defined in §423. See 42 CFR 423.2305
  • Other prescriber: means a health care professional other than a physician who is authorized under State law or other applicable law to write prescriptions. See 42 CFR 423.560
  • Other retail exposure: means an exposure (other than a securitization exposure, an equity exposure, a residential mortgage exposure, a pre-sold construction loan, a qualifying revolving exposure, or the residual value portion of a lease exposure) that is managed as part of a segment of exposures with homogeneous risk characteristics, not on an individual-exposure basis, and is either:

    (1) An exposure to an individual for non-business purposes. See 12 CFR 324.101

  • Out-of-network pharmacy: means a licensed pharmacy that is not under contract with a Part D sponsor to provide negotiated prices to Part D plan enrollees. See 42 CFR 423.100
  • Out-of-network pharmacy: means a licensed pharmacy that is not under contract with a Part D sponsor to provide negotiated prices to Part D plan enrollees. See 42 CFR 423.100
  • Outlier payment: means an additional payment beyond the Federal per diem payment amount for cases with unusually high costs. See 42 CFR 412.402
  • Outlier payment: means an additional payment beyond the long-term care hospital standard Federal payment rate or the site neutral payment rate (including, when applicable, the blended payment rate), as applicable, for cases with unusually high costs. See 42 CFR 412.503
  • Outpatient: means a person who has not been admitted as an inpatient but who is registered on the hospital or CAH records as an outpatient and receives services (rather than supplies alone) directly from the hospital or CAH. See 42 CFR 410.2
  • Outpatient hospital services: include services that are furnished either by the hospital directly or under arrangements made by the hospital with others. See 42 CFR 411.351
  • Outpatient prescription drugs: means all drugs covered by Medicare Part B or D, except for those drugs that are "covered ancillary services" as defined at §416. See 42 CFR 411.351
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Owner: means any individual or entity that has any partnership interest in, or that has 5 percent or more direct or indirect ownership of the provider or supplier as defined in sections 1124 and 1124A(A) of the Act. See 42 CFR 424.502
  • Ownership interest: means the possession of equity in the capital, the stock, or the profits of the disclosing entity. See 42 CFR 420.201
  • Part D sponsor: has the meaning given the term in 423. See 42 CFR 423.1002
  • Partial hospitalization services: means a distinct and organized intensive ambulatory treatment program that offers less than 24-hour daily care other than in an individual's home or in an inpatient or residential setting and furnishes the services as described in §410. See 42 CFR 410.2
  • Participating: refers to a hospital or other facility that meets the conditions of participation and has in effect a Medicare provider agreement. See 42 CFR 409.3
  • Participating: refers to a hospital, CAH, SNF, HHA, CORF, or hospice that has in effect an agreement to participate in Medicare. See 42 CFR 410.2
  • Participating hospital: means a hospital that has in effect a provider agreement to participate in Medicare. See 42 CFR 424.3
  • Participation agreement: means the written agreement required under §425. See 42 CFR 425.20
  • party: means the affected party or CMS, as appropriate. See 42 CFR 423.1002
  • party or an affected nonparty: A party or an affected nonparty, such as CMS, involved in proceedings before a reviewing entity. See 42 CFR 405.1801
  • Patient assessment instrument: refers to a document that contains clinical, demographic, and other information on a patient. See 42 CFR 412.602
  • Patient care services: means any task(s) performed by a physician in the group practice that address the medical needs of specific patients or patients in general, regardless of whether they involve direct patient encounters or generally benefit a particular practice. See 42 CFR 411.351
  • Performance period: means the calendar year that will be used to assess the quality of care furnished compared to cost. See 42 CFR 414.1205
  • Performance year: means the 12-month period beginning on January 1 of each year during the agreement period, unless otherwise specified in §425. See 42 CFR 425.20
  • Person: means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, not-for-profit corporation, unincorporated organization, government or governmental subdivision or agency. See 42 CFR 423.100
  • Person: means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, not-for-profit corporation, unincorporated organization, government or governmental subdivision or agency. See 42 CFR 423.100
  • Person with an ownership or control interest: means a person or corporation that--

    (1) Has an ownership interest totaling 5 percent or more in a disclosing entity. See 42 CFR 420.201

  • Personal health savings vehicle: means a vehicle through which individuals can set aside their own funds to pay for health care expenses, including covered Part D drugs, on a tax-free basis including any of the following--

    (1) A Health Savings Account (as defined under section 220 of the Internal Revenue Code). See 42 CFR 423.100

  • Physician: has the meaning given the term in section 1861(r) of the Act. See 42 CFR 422.561
  • Physician: has the meaning given the term in section 1861(r) of the Act. See 42 CFR 423.560
  • Physician: means a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor, as defined in section 1861(r) of the Act. See 42 CFR 411.351
  • Physician: means a doctor of medicine or osteopathy (as defined in section 1861(r)(1) of the Act). See 42 CFR 425.20
  • Physician in the group practice: means a member of the group practice, as well as an independent contractor physician during the time the independent contractor is furnishing patient care services (as defined in this section) for the group practice under a contractual arrangement directly with the group practice to provide services to the group practice's patients in the group practice's facilities. See 42 CFR 411.351
  • Physician incentive plan: means any compensation arrangement between an entity (or downstream contractor) and a physician or physician group that may directly or indirectly have the effect of reducing or limiting services furnished with respect to individuals enrolled with the entity. See 42 CFR 411.351
  • Physician or nonphysician practitioner organization: means any physician or nonphysician practitioner entity that enrolls in the Medicare program as a sole proprietorship or organizational entity. See 42 CFR 424.502
  • Physician organization: means a physician, a physician practice, or a group practice that complies with the requirements of §411. See 42 CFR 411.351
  • Physician Quality Reporting System: means the system established under section 1848(k) of the Act. See 42 CFR 414.1205
  • Physician services: means the following services to the extent that they are covered by Medicare:

    (1) Professional services of doctors of medicine and osteopathy (including osteopathic practitioners), doctors of optometry, doctors of podiatry, doctors of dental surgery and dental medicine, and chiropractors. See 42 CFR 414.2

  • Plaintiff: The person who files the complaint in a civil lawsuit.
  • Plan allowance: means the amount Part D plans that offer coverage other than defined standard coverage may use to determine their payment and Part D enrollees' cost-sharing for covered Part D drugs purchased at an out-of-network pharmacy or in a physician's office in accordance with the requirements of §423. See 42 CFR 423.100
  • Plan allowance: means the amount Part D plans that offer coverage other than defined standard coverage may use to determine their payment and Part D enrollees' cost-sharing for covered Part D drugs purchased at an out-of-network pharmacy or in a physician's office in accordance with the requirements of §423. See 42 CFR 423.100
  • Plan of care: means the establishment by a physician of a course of diagnosis or treatment (or both) for a particular patient, including the ordering of services. See 42 CFR 411.351
  • Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
  • Pleadings: Written statements of the parties in a civil case of their positions. In the federal courts, the principal pleadings are the complaint and the answer.
  • Point of pick-up: means the location of the beneficiary at the time he or she is placed on board the ambulance. See 42 CFR 414.605
  • political subdivisions: include counties, parishes, townships, cities, municipalities, towns, villages, and incorporated villages. See 42 CFR 417.150
  • Potential at-risk beneficiary: means a Part D eligible individual--

    (1) Who is identified using clinical guidelines (as defined in this section). See 42 CFR 423.100

  • Potential at-risk beneficiary: means a Part D eligible individual--

    (1) Who is identified using clinical guidelines (as defined in this section). See 42 CFR 423.100

  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
  • Pre-sold construction loan: means any one-to-four family residential construction loan to a builder that meets the requirements of section 618(a)(1) or (2) of the Resolution Trust Corporation Refinancing, Restructuring, and Improvement Act of 1991 (Pub. See 12 CFR 324.2
  • Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
  • Preclusion list: means a CMS compiled list of prescribers who--

    (1) Meet all of the following requirements:

    (i) The prescriber is currently revoked from Medicare for a reason other than that stated in §424. See 42 CFR 423.100

  • Preclusion list: means a CMS compiled list of individuals and entities that--

    (1) Meet all of the following requirements:

    (i) The individual or entity is currently revoked from Medicare for a reason other than that stated in §424. See 42 CFR 422.2

  • Preferred drug: means a covered Part D drug on a Part D plan's formulary for which beneficiary cost-sharing is lower than for a non-preferred drug in the plan's formulary. See 42 CFR 423.100
  • Preferred pharmacy: means a network pharmacy that offers covered Part D drugs at negotiated prices to Part D enrollees at lower levels of cost-sharing than apply at a non-preferred pharmacy under its pharmacy network contract with a Part D plan. See 42 CFR 423.100
  • Prescription order: means a written order submitted by the participating CAP physician to the approved CAP vendor that meets the requirements of this subpart. See 42 CFR 414.902
  • Preventive services: means all of the following:

    (1) The specific services listed in section 1861(ww)(2) of the Act, with the explicit exclusion of electrocardiograms. See 42 CFR 410.2

  • Primary care services: means the set of services identified by the HCPCS and revenue center codes designated under §425. See 42 CFR 425.20
  • Primary recipient: means any recipient that is authorized or required to extend Federal financial assistance to another recipient for the purpose of carrying out a program. See 18 CFR 705.2
  • Principal diagnosis: means the condition established after study to be chiefly responsible for occasioning the admission of the patient to the inpatient psychiatric facility. See 42 CFR 412.402
  • Principle: Providers receiving payment on the basis of reimbursable cost must provide adequate cost data. See 42 CFR 413.24
  • Prior authorization: means the process through which a request for provisional affirmation of coverage is submitted to CMS or its contractors for review before the service is provided to the beneficiary and before the claim is submitted for processing. See 42 CFR 419.81
  • Professional courtesy: means the provision of free or discounted health care items or services to a physician or his or her immediate family members or office staff. See 42 CFR 411.351
  • Program: includes any program, project, or activity for the provision of services, financial aid, or other benefits to individuals (including education or training, health, welfare, rehabilitation, housing, or other services, whether provided through employees of the recipient of Federal financial assistance or provided by others through contracts or other arrangements with the recipient, and including work opportunities), or for the provision of facilities for furnishing services, financial aid or other benefits to individuals. See 18 CFR 705.2
  • Program size: means the estimated population of potential at-risk beneficiaries in drug management programs (described in §423. See 42 CFR 423.100
  • prospectus: means a prospectus meeting the requirements of section 10(a) of the Securities Act of 1933 as amended. See 17 CFR 270.0-1
  • provider: includes a hospital (as described in part 482 of this chapter), hospice program (as described in §418. See 42 CFR 405.1801
  • Provider network: means the providers with which an MA organization contracts or makes arrangements to furnish covered health care services to Medicare enrollees under an MA coordinated care plan or network PFFS plan. See 42 CFR 422.2
  • Providers: In order to be paid for covered services furnished to Medicare beneficiaries, a provider must file a cost report with its contractor as specified in §413. See 42 CFR 405.1801
  • Provisional affirmation: means a preliminary finding that a future claim meets the Medicare coverage, coding, and payment rules in chapter IV of this title or in Title XVIII of the Social Security Act. See 42 CFR 419.81
  • Proxy voting: The practice of allowing a legislator to cast a vote in committee for an absent legislator.
  • Public debt: Cumulative amounts borrowed by the Treasury Department or the Federal Financing Bank from the public or from another fund or account. The public debt does not include agency debt (amounts borrowed by other agencies of the Federal Government). The total public debt is subject to a statutory limit.
  • Public entity: means the 50 states, Puerto Rico, Guam, the Virgin Islands, the Northern Mariana Islands and American Samoa and their political subdivisions, the District of Columbia, and any agency or instrumentality of the foregoing, and political subdivisions include counties, parishes, townships, cities, municipalities, towns, villages, and incorporated villages. See 42 CFR 417.150
  • Publicly-traded: means traded on:

    (1) Any exchange registered with the SEC as a national securities exchange under section 6 of the Securities Exchange Act. See 12 CFR 324.2

  • Qualified actuary: means a member in good standing of the American Academy of Actuaries or a person recognized by the Academy as qualified for membership, or a person who has otherwise demonstrated competency in the field of actuarial determination and is satisfactory to CMS. See 42 CFR 422.350
  • Qualified hospital: means a facility that--

    (a) Is primarily engaged in providing, by or under the supervision of doctors of medicine or osteopathy, inpatient services for the diagnosis, treatment, and care or rehabilitation of persons who are sick, injured, or disabled. See 42 CFR 409.3

  • Qualified prescription drug coverage: means any standard prescription drug coverage or alternative prescription drug coverage

    Required prescription drug coverage means coverage of Part D drugs under an MA-PD plan that consists of either--

    (1) Basic prescription drug coverage. See 42 CFR 423.100

  • Qualified prescription drug coverage: means any standard prescription drug coverage or alternative prescription drug coverage

    Required prescription drug coverage means coverage of Part D drugs under an MA-PD plan that consists of either--

    (1) Basic prescription drug coverage. See 42 CFR 423.100

  • Qualifying cross-product master netting agreement: means a qualifying master netting agreement that provides for termination and close-out netting across multiple types of financial transactions or qualifying master netting agreements in the event of a counterparty's default, provided that the underlying financial transactions are OTC derivative contracts, eligible margin loans, or repo-style transactions. See 12 CFR 324.101
  • Qualifying emergency department: means an emergency department that is staffed and equipped to furnish a comprehensive array of emergency services and meeting the definitions of a dedicated emergency department as specified in §489. See 42 CFR 412.402
  • Qualifying master netting agreement: means a written, legally enforceable agreement provided that:

    (1) The agreement creates a single legal obligation for all individual transactions covered by the agreement upon an event of default following any stay permitted by paragraph (2) of this definition, including upon an event of receivership, conservatorship, insolvency, liquidation, or similar proceeding, of the counterparty. See 12 CFR 324.2

  • Qualifying plan: means a full-risk or limited-risk prescription drug plan, as defined in §423. See 42 CFR 423.855
  • Quality measures: means the measures defined by the Secretary, under section 1899 of the Act, to assess the quality of care furnished by an ACO, such as measures of clinical processes and outcomes, patient and, where practicable, caregiver experience of care and utilization. See 42 CFR 425.20
  • Quorum: The number of legislators that must be present to do business.
  • Radiation therapy services and supplies: means those particular services and supplies, including (effective January 1, 2007) therapeutic nuclear medicine services and supplies, so identified on the List of CPT/HCPCS Codes. See 42 CFR 411.351
  • Radiology and certain other imaging services: means those particular services so identified on the List of CPT/HCPCS Codes. See 42 CFR 411.351
  • Recess: A temporary interruption of the legislative business.
  • Reconsideration: means a review of an adverse coverage determination or at-risk determination by an independent review entity (IRE), the evidence and findings upon which it was based, and any other evidence the enrollee submits or the IRE obtains. See 42 CFR 423.560
  • Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. Source: FDIC
  • Redetermination: means a review of an adverse coverage determination or at-risk determination by a Part D plan sponsor, the evidence and findings upon which it is based, and any other evidence the enrollee submits or the Part D plan sponsor obtains. See 42 CFR 423.560
  • Referring physician: means a physician who makes a referral as defined in this section or who directs another person or entity to make a referral or who controls referrals made by another person or entity. See 42 CFR 411.351
  • Regulated financial institution: means a financial institution subject to consolidated supervision and regulation comparable to that imposed on the following U. See 12 CFR 324.2
  • regulations: refer to the rules and regulations adopted by the Commission pursuant to the Act, including the forms for registration and reports and the accompanying instructions thereto. See 17 CFR 270.0-1
  • Related entity: means any entity that is related to the MA organization by common ownership or control and

    (1) Performs some of the MA organization's management functions under contract or delegation. See 42 CFR 422.2

  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • Remand: When an appellate court sends a case back to a lower court for further proceedings.
  • Remuneration: means any payment or other benefit made directly or indirectly, overtly or covertly, in cash or in kind, except that the following are not considered remuneration for purposes of this section:

    (1) The forgiveness of amounts owed for inaccurate tests or procedures, mistakenly performed tests or procedures, or the correction of minor billing errors. See 42 CFR 411.351

  • Repo-style transaction: means a repurchase or reverse repurchase transaction, or a securities borrowing or securities lending transaction, including a transaction in which the FDIC-supervised institution acts as agent for a customer and indemnifies the customer against loss, provided that:

    (1) The transaction is based solely on liquid and readily marketable securities, cash, or gold. See 12 CFR 324.2

  • Reporting period: means the period specified by CMS for which an HCPP must report its costs and utilization. See 42 CFR 417.800
  • Representative: means an individual appointed by an enrollee or other party, or authorized under State or other applicable law, to act on behalf of an enrollee or other party involved in the grievance or appeal. See 42 CFR 422.561
  • Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
  • Resecuritization: means a securitization which has more than one underlying exposure and in which one or more of the underlying exposures is a securitization exposure. See 12 CFR 324.2
  • resident: is synonymous with the terms intern and fellow. See 42 CFR 415.152
  • Resident classification system: means a system for classifying SNF residents into mutually exclusive groups based on clinical, functional, and resource-based criteria. See 42 CFR 413.333
  • Residential mortgage exposure: means an exposure (other than a securitization exposure, equity exposure, statutory multifamily mortgage, or presold construction loan):

    (1)(i) That is primarily secured by a first or subsequent lien on one-to-four family residential property. See 12 CFR 324.2

  • Responsible agency official: means the Director of the Water Resources Council or his designee. See 18 CFR 705.2
  • Retail: (i) A retail exposure of an FDIC-supervised institution is in default if:

    (A) The exposure is 180 days past due, in the case of a residential mortgage exposure or revolving exposure. See 12 CFR 324.101

  • Retail exposure: means a residential mortgage exposure, a qualifying revolving exposure, or an other retail exposure. See 12 CFR 324.101
  • Retail exposure subcategory: means the residential mortgage exposure, qualifying revolving exposure, or other retail exposure subcategory. See 12 CFR 324.101
  • Retail pharmacy: means any licensed pharmacy that is open to dispense prescription drugs to the walk-in general public from which Part D enrollees could purchase a covered Part D drug without being required to receive medical services from a provider or institution affiliated with that pharmacy. See 42 CFR 423.100
  • Retail pharmacy: means any licensed pharmacy that is open to dispense prescription drugs to the walk-in general public from which Part D enrollees could purchase a covered Part D drug without being required to receive medical services from a provider or institution affiliated with that pharmacy. See 42 CFR 423.100
  • Revenue obligation: means a bond or similar obligation that is an obligation of a PSE, but which the PSE is committed to repay with revenues from the specific project financed rather than general tax funds. See 12 CFR 324.2
  • Reviewing entity: means the contractor hearing officer(s), a CMS reviewing official, the Board, or the Administrator. See 42 CFR 405.1801
  • Revocable trust: A trust agreement that can be canceled, rescinded, revoked, or repealed by the grantor (person who establishes the trust).
  • Revolving credit: A credit agreement (typically a credit card) that allows a customer to borrow against a preapproved credit line when purchasing goods and services. The borrower is only billed for the amount that is actually borrowed plus any interest due. (Also called a charge account or open-end credit.) Source: OCC
  • RFB plan: means an MA plan that is offered by an RFB society. See 42 CFR 422.2
  • Risk contract: means a Medicare contract under which CMS pays the HMO or CMP on a risk basis for Medicare covered services. See 42 CFR 417.401
  • Risk parameter: means a variable used in determining risk-based capital requirements for wholesale and retail exposures, specifically probability of default (PD), loss given default (LGD), exposure at default (EAD), or effective maturity (M). See 12 CFR 324.101
  • Risk score: means the beneficiary risk score derived from the CMS Hierarchical Condition Categories (HCC) model. See 42 CFR 414.1205
  • Routine care items and services: refers to items and services that are otherwise generally available to Medicare beneficiaries (that is, a benefit category exists, it is not statutorily excluded, and there is no national noncoverage decision) that are furnished during a clinical study and that would be otherwise furnished even if the beneficiary were not enrolled in a clinical study. See 42 CFR 405.201
  • Routine delivery: means delivery of a drug within 2 business days in appropriate shipping and packaging in all areas of the United States and its territories, with the exception of the Pacific Territories. See 42 CFR 414.902
  • Rural: means a five-digit ZIP code in which the population density is less than 1,000 individuals per square mile. See 42 CFR 423.100
  • Rural: means a five-digit ZIP code in which the population density is less than 1,000 individuals per square mile. See 42 CFR 423.100
  • Rural area: means any area not listed as a place having a population of 2,500 or more in Document #PC(1)A, "Number of Inhabitants" Table VI, "Population of Places" and not listed as an urbanized area in Table XI, "Population of Urbanized Areas" of the same document (1970 Census or most recent update of this document, Bureau of Census, U. See 42 CFR 417.1
  • Rural area: means an area that is not an urban area as defined at §412. See 42 CFR 411.351
  • Rural area: means for cost reporting periods beginning January 1, 2005, with respect to discharges occurring during the period covered by such cost reports but before July 1, 2006, an area as defined in §412. See 42 CFR 412.402
  • Rural area: means an area located outside an urban area, or a rural census tract within a Metropolitan Statistical Area as determined under the most recent version of the Goldsmith modification as determined by the Office of Rural Health Policy of the Health Resources and Services Administration. See 42 CFR 414.605
  • Same building: means a structure with, or combination of structures that share, a single street address as assigned by the U. See 42 CFR 411.351
  • Savings and loan holding company: means a savings and loan holding company as defined in section 10 of the Home Owners' Loan Act (12 U. See 12 CFR 324.2
  • Scenario analysis: means a systematic process of obtaining expert opinions from business managers and risk management experts to derive reasoned assessments of the likelihood and loss impact of plausible high-severity operational losses. See 12 CFR 324.101
  • Scope: This subpart establishes the requirements for coverage and reimbursement of rural health clinic and Federally qualified health center services under Medicare. See 42 CFR 405.2401
  • Secretary: means the Secretary of Health and Human Services and any other officer or employee of the Department of Health and Human Services to whom the authority involved has been delegated. See 42 CFR 417.1
  • Secretary: means the Secretary of Health and Human Services or his or her delegate. See 42 CFR 405.2401
  • Securities Exchange Act: means the Securities Exchange Act of 1934 (15 U. See 12 CFR 324.2
  • Securitization: means a transaction in which:

    (1) All or a portion of the credit risk of one or more underlying exposures is transferred to one or more third parties. See 12 CFR 324.202

  • Securitization position: means a covered position that is:

    (1) An on-balance sheet or off-balance sheet credit exposure (including credit-enhancing representations and warranties) that arises from a securitization (including a resecuritization). See 12 CFR 324.202

  • Senior housing facility plan: means an MA coordinated care plan that--

    (1) Restricts enrollment to individuals who reside in a continuing care retirement community as defined in §422. See 42 CFR 422.2

  • Separate account: means a legally segregated pool of assets owned and held by an insurance company and maintained separately from the insurance company's general account assets for the benefit of an individual contract holder. See 12 CFR 324.2
  • separate account: shall mean an account established and maintained by an insurance company pursuant to the laws of any state or territory of the United States, or of Canada or any province thereof, under which income, gains and losses, whether or not realized, from assets allocated to such account, are, in accordance with the applicable contract, credited to or charged against such account without regard to other income, gains or losses of the insurance company and the term "variable annuity contract" shall mean any accumulation or annuity contract, any portion thereof, or any unit of interest or participation therein pursuant to which the value of the contract, either prior or subsequent to annuitization, or both, varies according to the investment experience of the separate account in which the contract participates. See 17 CFR 270.0-1
  • Service area: means a geographic area, defined through zip codes, census tracts, or other geographic measurements, that is the area, as determined by CMS, within which the HMO furnishes basic and supplemental health services and makes them available and accessible to all its enrollees in accordance with §417. See 42 CFR 417.1
  • Service area: means a geographic area that for local MA plans is a county or multiple counties, and for MA regional plans is a region approved by CMS within which an MA-eligible individual may enroll in a particular MA plan offered by an MA organization. See 42 CFR 422.2
  • Service of process: The service of writs or summonses to the appropriate party.
  • Servicer cash advance facility: means a facility under which the servicer of the underlying exposures of a securitization may advance cash to ensure an uninterrupted flow of payments to investors in the securitization, including advances made to cover foreclosure costs or other expenses to facilitate the timely collection of the underlying exposures. See 12 CFR 324.2
  • Severe or disabling chronic condition: means for the purpose of defining a special needs individual, an MA eligible individual who has one or more co-morbid and medically complex chronic conditions that are substantially disabling or life-threatening, has a high risk of hospitalization or other significant adverse health outcomes, and requires specialized delivery systems across domains of care. See 42 CFR 422.2
  • Shared losses: means a portion of the ACO's performance year Medicare fee-for-service Parts A and B expenditures, above the applicable benchmark, it must repay to CMS. See 42 CFR 425.20
  • Shared savings: means a portion of the ACO's performance year Medicare fee-for-service Parts A and B expenditures, below the applicable benchmark, it is eligible to receive payment for from CMS. See 42 CFR 425.20
  • Significant investment in the capital of an unconsolidated financial institution: means an investment by an advanced approaches FDIC-supervised institution in the capital of an unconsolidated financial institution where the advanced approaches FDIC-supervised institution owns more than 10 percent of the issued and outstanding common stock of the unconsolidated financial institution. See 12 CFR 324.2
  • Single source drug: means a drug described by section 1847A(c)(6)(D) of the Act. See 42 CFR 414.902
  • Small Business Act: means the Small Business Act (15 U. See 12 CFR 324.2
  • Small Business Investment Act: means the Small Business Investment Act of 1958 (15 U. See 12 CFR 324.2
  • Small capital expenditure: means expenditures for--

    (1) Equipment as defined in 45 CFR 75. See 42 CFR 417.911

  • Solo practitioner: means a single Taxpayer Identification Number (TIN) with one eligible professional who is identified by an individual National Provider Identifier (NPI) billing under the TIN. See 42 CFR 414.1205
  • Sovereign: means a central government (including the U. See 12 CFR 324.2
  • Sovereign debt position: means a direct exposure to a sovereign entity. See 12 CFR 324.202
  • Sovereign default: means noncompliance by a sovereign with its external debt service obligations or the inability or unwillingness of a sovereign government to service an existing loan according to its original terms, as evidenced by failure to pay principal and interest timely and fully, arrearages, or restructuring. See 12 CFR 324.2
  • Special needs individual: means an MA eligible individual who is institutionalized, as defined above, is entitled to medical assistance under a State plan under title XIX, or has a severe or disabling chronic condition(s) and would benefit from enrollment in a specialized MA plan. See 42 CFR 422.2
  • Specialized MA Plans for Special Needs Individuals: means an MA coordinated care plan that exclusively enrolls special needs individuals as set forth in §422. See 42 CFR 422.2
  • Specialty hospital: means a subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Act) that is primarily or exclusively engaged in the care and treatment of one of the following:

    (1) Patients with a cardiac condition. See 42 CFR 411.351

  • Specialty tier: means a formulary cost-sharing tier dedicated to very high cost Part D drugs and biological products that exceed a cost threshold established by the Secretary. See 42 CFR 423.560
  • Specific risk: means the risk of loss on a position that could result from factors other than broad market movements and includes event risk, default risk, and idiosyncratic risk. See 12 CFR 324.202
  • Specific wrong-way risk: means wrong-way risk that arises when either:

    (1) The counterparty and issuer of the collateral supporting the transaction. See 12 CFR 324.2

  • Speculative grade: means the reference entity has adequate capacity to meet financial commitments in the near term, but is vulnerable to adverse economic conditions, such that should economic conditions deteriorate, the reference entity would present an elevated default risk. See 12 CFR 324.2
  • Standard prescription drug coverage: means coverage of Part D drugs that meets the requirements of §423. See 42 CFR 423.100
  • Standard prescription drug coverage: means coverage of Part D drugs that meets the requirements of §423. See 42 CFR 423.100
  • Standardized market risk-weighted assets: means the standardized measure for market risk calculated under §324. See 12 CFR 324.2
  • State savings association: means a State savings association as defined in section 3(b)(3) of the Federal Deposit Insurance Act (12 U. See 12 CFR 324.2
  • Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.
  • Statutory accounting practices: means those accounting principles or practices prescribed or permitted by the domiciliary State insurance department in the State that PSO operates. See 42 CFR 422.350
  • Statutory multifamily mortgage: means a loan secured by a multifamily residential property that meets the requirements under section 618(b)(1) of the Resolution Trust Corporation Refinancing, Restructuring, and Improvement Act of 1991, and that meets the following criteria:9

    9The types of loans that qualify as loans secured by multifamily residential properties are listed in the instructions for preparation of the Call Report. See 12 CFR 324.2

  • Step therapy: means a utilization management policy for coverage of drugs that begins medication for a medical condition with the most preferred or cost effective drug therapy and progresses to other drug therapies if medically necessary. See 42 CFR 422.2
  • Step-down method: This method recognizes that services furnished by certain nonrevenue-producing departments or centers are utilized by certain other nonrevenue-producing centers as well as by the revenue-producing centers. See 42 CFR 413.24
  • Sub-speculative grade: means the reference entity depends on favorable economic conditions to meet its financial commitments, such that should such economic conditions deteriorate the reference entity likely would default on its financial commitments. See 12 CFR 324.2
  • Subordinated debt: means an obligation that is owed by an organization, that the creditor of the obligation, by law, agreement, or otherwise, has a lower repayment rank in the hierarchy of creditors than another creditor. See 42 CFR 422.350
  • Subscriber: means an enrollee who has entered into a contractual relationship with the HMO or who is responsible for making payments for basic health services (and contracted for supplemental health services) to the HMO or on whose behalf these payments are made. See 42 CFR 417.1
  • Suburban: means a five-digit ZIP code in which the population density is between 1,000 and 3,000 individuals per square mile. See 42 CFR 423.100
  • Supplemental benefits: means benefits offered by Part D plans, other than employer group health or waiver plans, that meet the requirements of §423. See 42 CFR 423.100
  • Supplemental benefits: means benefits offered by Part D plans, other than employer group health or waiver plans, that meet the requirements of §423. See 42 CFR 423.100
  • Supplemental health services: means the health services described in §417. See 42 CFR 417.1
  • Synthetic exposure: means an exposure whose value is linked to the value of an investment in the FDIC-supervised institution's own capital instrument or to the value of an investment in the capital of an unconsolidated financial institution. See 12 CFR 324.2
  • Synthetic securitization: means a transaction in which:

    (1) All or a portion of the credit risk of one or more underlying exposures is retained or transferred to one or more third parties through the use of one or more credit derivatives or guarantees (other than a guarantee that transfers only the credit risk of an individual retail exposure). See 12 CFR 324.2

  • Tangible capital: means the amount of core capital (Tier 1 capital), as defined in accordance with §324. See 12 CFR 324.2
  • Tangible equity: means the amount of Tier 1 capital, as calculated in accordance with §324. See 12 CFR 324.2
  • Taxable year: means the 12-month period (calendar or fiscal year) for which the individual files his or her income tax return. See 42 CFR 408.3
  • Teaching hospital: means a hospital engaged in an approved GME residency program in medicine, osteopathy, dentistry, or podiatry. See 42 CFR 415.152
  • Teaching physician: means a physician (other than another resident) who involves residents in the care of his or her patients. See 42 CFR 415.152
  • Teaching setting: means any provider, hospital-based provider, or nonprovider settings in which Medicare payment for the services of residents is made under the direct GME payment provisions of §§413. See 42 CFR 415.152
  • Therapeutically equivalent: refers to drugs that are rated as therapeutic equivalents under the Food and Drug Administration's most recent publication of "Approved Drug Products with Therapeutic Equivalence Evaluations. See 42 CFR 423.100
  • Third party payment arrangement: means any contractual or similar arrangement under which a person has a legal obligation to pay for covered Part D drugs. See 42 CFR 423.100
  • Timely delivery: means delivery of a CAP drug within the defined routine and emergency delivery timeframes. See 42 CFR 414.902
  • Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
  • Total capital: means the sum of tier 1 capital and tier 2 capital. See 12 CFR 324.2
  • Total capital minority interest: means the total capital of a consolidated subsidiary of an FDIC-supervised institution that is not owned by the FDIC-supervised institution. See 12 CFR 324.2
  • Total wholesale and retail risk-weighted assets: means the sum of:

    (1) Risk-weighted assets for wholesale exposures that are not IMM exposures, cleared transactions, or default fund contributions to non-defaulted obligors and segments of non-defaulted retail exposures. See 12 CFR 324.101

  • Trading position: means a position that is held by the FDIC-supervised institution for the purpose of short-term resale or with the intent of benefiting from actual or expected short-term price movements, or to lock in arbitrage profits. See 12 CFR 324.202
  • Traditional securitization: means a transaction in which:

    (1) All or a portion of the credit risk of one or more underlying exposures is transferred to one or more third parties other than through the use of credit derivatives or guarantees. See 12 CFR 324.2

  • Tranche: means all securitization exposures associated with a securitization that have the same seniority level. See 12 CFR 324.2
  • Transaction: means an instance or process of two or more persons or entities doing business. See 42 CFR 411.351
  • Transfer: means the release of a Medicare inpatient from an inpatient rehabilitation facility to another inpatient rehabilitation facility, a short-term, acute-care prospective payment hospital, a long-term care hospital as described in §412. See 42 CFR 412.602
  • Trust account: A general term that covers all types of accounts in a trust department, such as estates, guardianships, and agencies. Source: OCC
  • Trustee: A person or institution holding and administering property in trust.
  • Truth in Lending Act: The Truth in Lending Act is a federal law that requires lenders to provide standardized information so that borrowers can compare loan terms. In general, lenders must provide information on Source: OCC
  • Two-sided model: means a model under which the ACO may share savings with the Medicare program, if it meets the requirements for doing so, and is also liable for sharing any losses incurred under subpart G of this part. See 42 CFR 425.20
  • Two-way market: means a market where there are independent bona fide offers to buy and sell so that a price reasonably related to the last sales price or current bona fide competitive bid and offer quotations can be determined within one day and settled at that price within a relatively short time frame conforming to trade custom. See 12 CFR 324.202
  • Two-way market: means a market where there are independent bona fide offers to buy and sell so that a price reasonably related to the last sales price or current bona fide competitive bid and offer quotations can be determined within one day and settled at that price within a relatively short time frame conforming to trade custom. See 12 CFR 324.2
  • Unconditionally cancelable: means with respect to a commitment, that an FDIC-supervised institution may, at any time, with or without cause, refuse to extend credit under the commitment (to the extent permitted under applicable law). See 12 CFR 324.2
  • Uncovered expenditures: means those expenditures for health care services that are the obligation of an organization, for which an enrollee may also be liable in the event of the organization's insolvency and for which no alternative arrangements have been made that are acceptable to CMS. See 42 CFR 422.350
  • Underlying exposures: means one or more exposures that have been securitized in a securitization transaction. See 12 CFR 324.2
  • Uniform Commercial Code: A set of statutes enacted by the various states to provide consistency among the states' commercial laws. It includes negotiable instruments, sales, stock transfers, trust and warehouse receipts, and bills of lading. Source: OCC
  • Unit of measure: means the level (for example, organizational unit or operational loss event type) at which the FDIC-supervised institution's operational risk quantification system generates a separate distribution of potential operational losses. See 12 CFR 324.101
  • Uphold: The decision of an appellate court not to reverse a lower court decision.
  • Urban: means a five-digit ZIP code in which the population density is greater than 3,000 individuals per square mile. See 42 CFR 423.100
  • Urban: means a five-digit ZIP code in which the population density is greater than 3,000 individuals per square mile. See 42 CFR 423.100
  • Urban area: means for cost reporting periods beginning on or after January 1, 2005, with respect to discharges occurring during the period covered by such cost reports but before July 1, 2006, an area as defined in §412. See 42 CFR 412.402
  • Urban area: means a Metropolitan Statistical Area, as defined by the Executive Office of Management and Budget. See 42 CFR 414.605
  • Urgently needed services: means covered services that are needed by an enrollee who is temporarily absent from the HMO's or CMP's geographic area and that--

    (1) Are required in order to prevent serious deterioration of the enrollee's health as a result of unforeseen injury or illness. See 42 CFR 417.401

  • User fees: Fees charged to users of goods or services provided by the government. In levying or authorizing these fees, the legislature determines whether the revenue should go into the treasury or should be available to the agency providing the goods or services.
  • Valid prescription: means a prescription that complies with all applicable State law requirements constituting a valid prescription. See 42 CFR 423.100
  • Value-based payment modifier: means the percentage as determined under §414. See 42 CFR 414.1205
  • Variable Rate: Having a "variable" rate means that the APR changes from time to time based on fluctuations in an external rate, normally the Prime Rate. This external rate is known as the "index." If the index changes, the variable rate normally changes. Also see Fixed Rate.
  • Variation margin: means financial collateral that is subject to a collateral agreement provided by one party to its counterparty to meet the performance of the first party's obligations under one or more transactions between the parties as a result of a change in value of such obligations since the last time such financial collateral was provided. See 12 CFR 324.2
  • Variation margin agreement: means an agreement to collect or post variation margin. See 12 CFR 324.2
  • Variation margin amount: means the fair value amount of the variation margin, as adjusted by the standard supervisory haircuts under §324. See 12 CFR 324.2
  • Variation margin threshold: means the amount of credit exposure of a FDIC-supervised institution to its counterparty that, if exceeded, would require the counterparty to post variation margin to the FDIC-supervised institution pursuant to the variation margin agreement. See 12 CFR 324.2
  • Venue: The geographical location in which a case is tried.
  • Visiting nurse services: means part-time or intermittent nursing care and related medical supplies (other than drugs or biologicals) furnished by a registered professional nurse or licensed practical nurse to a homebound patient. See 42 CFR 405.2401
  • Volatility derivative contract: means a derivative contract in which the payoff of the derivative contract explicitly depends on a measure of the volatility of an underlying risk factor to the derivative contract. See 12 CFR 324.2
  • Voluntary termination: means that a provider or supplier, including an individual physician or nonphysician practitioner, submits written confirmation to CMS of its decision to discontinue enrollment in the Medicare program. See 42 CFR 424.502
  • Wholesale: (i) An FDIC-supervised institution's wholesale obligor is in default if:

    (A) The FDIC-supervised institution determines that the obligor is unlikely to pay its credit obligations to the FDIC-supervised institution in full, without recourse by the FDIC-supervised institution to actions such as realizing collateral (if held). See 12 CFR 324.101

  • Wholesale exposure: means a credit exposure to a company, natural person, sovereign, or governmental entity (other than a securitization exposure, retail exposure, pre-sold construction loan, or equity exposure). See 12 CFR 324.101
  • Wholesale exposure subcategory: means the HVCRE or non-HVCRE wholesale exposure subcategory. See 12 CFR 324.101
  • Wholly owned supplier: means a supplier whose total ownership interest is held by a provider or by a person, persons, or other entity with an ownership or control interest in a provider. See 42 CFR 420.201
  • Wrong-way risk: means the risk that arises when an exposure to a particular counterparty is positively correlated with the probability of default of such counterparty itself. See 12 CFR 324.2