[Code of Federal Regulations]
[Title 5, Volume 2]
[Revised as of January 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 5CFR890.1050]

[Page 499-500]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)
 
PART 890_FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents
 
Subpart J_Administrative Sanctions Imposed Against Health Care Providers
 
Sec. 890.1050  Exception 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.

[[Page 500]]

                              Reinstatement