§ 890.1050Exception to a provider's debarment for an individual enrollee.
(a)Request by a covered individual. Any individual enrolled in FEHBP may submit a request through their FEHBP carrier for continued payment of items or services furnished by a debarred provider to any person covered under the enrollment. Requests shall not be accepted for continued payments to suspended providers.
(b)OPM action on the request. OPM shall consider the recommendation of the FEHBP carrier before acting on the request. To be approved, the request shall demonstrate that:
(1) Interrupting an existing, ongoing course of treatment by the provider would have a detrimental effect on the covered individual's health or safety; or
(2) The covered individual does not have access to an alternative source of the same or equivalent health care items or services within a reasonably accessible service area.
(c)Scope of the exception. An approved exception applies only to the covered individual(s) who requested it, or on whose behalf it was requested. The governmentwide effect of the provider's debarment under section 2455 of the Federal Acquisition Streamlining Act (Pub. L. 103-355) is not altered by an exception.
(d)Provider requests not allowed. OPM shall not consider an exception request submitted by a provider on behalf of a covered individual.
(e)Debarring official's decision is final. The debarring official's decision on an exception request is not subject to further administrative review or reconsideration.
Title 5 published on 2014-01-01
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