remuneration

(6)The term “remuneration” includes the waiver of coinsurance and deductible amounts (or any part thereof), and transfers of items or services for free or for other than fair market value. The term “remuneration” does not include— (A)the waiver of coinsurance and deductible amounts by a person, if— (i)the waiver is not offered as part of any advertisement or solicitation; (ii)the person does not routinely waive coinsurance or deductible amounts; and (iii)the person— (I)waives the coinsurance and deductible amounts after determining in good faith that the individual is in financial need; or (II)fails to collect coinsurance or deductible amounts after making reasonable collection efforts; (B)subject to subsection (n), any permissible practice described in any subparagraph ofsection 1320a–7b(b)(3) of this titleor in regulations issued by the Secretary; (C)differentials in coinsurance and deductible amounts as part of a benefit plan design as long as the differentials have been disclosed in writing to all beneficiaries, third party payers, and providers, to whom claims are presented and as long as the differentials meet the standards as defined in regulations promulgated by the Secretary not later than 180 days after; (D)incentives given to individuals to promote the delivery of preventive care as determined by the Secretary in regulations so promulgated; (E)a reduction in the copayment amount for covered OPD services under of this title; or  (F)any other remuneration which promotes access to care and poses a low risk of harm to patients and Federal health care programs (as defined insection 1320a–7b(f) of this titleand designated by the Secretary under regulations); (G)the offer or transfer of items or services for free or less than fair market value by a person, if— (i)the items or services consist of coupons, rebates, or other rewards from a retailer; (ii)the items or services are offered or transferred on equal terms available to the general public, regardless of health insurance status; and (iii)the offer or transfer of the items or services is not tied to the provision of other items or services reimbursed in whole or in part by the program under subchapter XVIII or a State health care program (as defined insection 1320a–7(h) of this title); (H)the offer or transfer of items or services for free or less than fair market value by a person, if— (i)the items or services are not offered as part of any advertisement or solicitation; (ii)the items or services are not tied to the provision of other services reimbursed in whole or in part by the program under subchapter XVIII or a State health care program (as so defined); (iii)there is a reasonable connection between the items or services and the medical care of the individual; and (iv)the person provides the items or services after determining in good faith that the individual is in financial need; (I)effective on a date specified by the Secretary (but not earlier than), the waiver by a PDP sponsor of a prescription drug plan under part D of subchapter XVIII or an MA organization offering an MA–PD plan under part C of such subchapter of any copayment for the first fill of a covered part D drug (as defined insection 1395w–102(e) of this title) that is a generic drug for individuals enrolled in the prescription drug plan or MA–PD plan, respectively; or (J)the provision of telehealth technologies (as defined by the Secretary) on or after, by a provider of services or a renal dialysis facility (as such terms are defined for purposes of subchapter XVIII) to an individual with end stage renal disease who is receiving home dialysis for which payment is being made under part B of such subchapter, if— (i)the telehealth technologies are not offered as part of any advertisement or solicitation; (ii)the telehealth technologies are provided for the purpose of furnishing telehealth services related to the individual’s end stage renal disease; and (iii)the provision of the telehealth technologies meets any other requirements set forth in regulations promulgated by the Secretary.

Source

42 USC § 1320a-7a(i)(6)


Scoping language

For the purposes of this section
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