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Home Page > Executive Branch > Code of Federal Regulations > Electronic Code of Federal Regulations
e-CFR Data is current as of February 4, 2010
TITLE 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER C--MEDICAL ASSISTANCE PROGRAMS
PART 447--PAYMENTS FOR SERVICES
Subpart A--PAYMENTS: GENERAL PROVISIONS
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| Prohibition against reassignment of provider claims. |
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| Acceptance of State payment as payment in full. |
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| Provider restrictions: State plan requirements. |
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| Reduction of payments to providers. |
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| Direct payments to certain recipients for physicians' or dentists' services. |
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| Withholding the Federal share of payments to Medicaid providers to recover Medicare overpayments. |
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| Withholding Medicare payments to recover Medicaid overpayments. |
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| Payments for reserving beds in institutions. |
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| Timely claims payment by MCOs. |
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| Cost sharing: Basis and purpose. |
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| Requirements and options. |
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| Minimum and maximum income-related charges. |
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| Applicability; specification; multiple charges. |
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| Maximum allowable charges. |
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| Restrictions on payments to providers. |
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| Payments to prepaid capitation organizations. |
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| FFP: Conditions relating to cost sharing. |
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| Cost-sharing requirements for services furnished by MCOs. |
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| Alternative premiums and cost sharing: Basis, purpose and scope. |
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| Alternative premiums, enrollment fees, or similar fees: State plan requirements. |
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| General alternative premium protections. |
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| Alternative copayments, coinsurance, deductibles, or similar cost sharing charges: State plan requirements. |
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| General alternative cost sharing protections. |
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| Alternative premium and cost sharing exemptions and protections for individuals with family incomes at or below 100 percent of the FPL. |
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| Alternative premium and cost sharing exemptions and protections for individuals with family incomes above 100 percent but at or below 150 percent of the FPL. |
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| Alternative premium and cost sharing protections for individuals with family incomes above 150 percent of the FPL. |
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| Aggregate limits on alternative premiums and cost sharing. |
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| Enforceability of alternative premiums and cost sharing. |
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| Restrictions on payments to providers. |
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| Options for claiming FFP payment for section 1920A presumptive eligibility medical assistance payments. |
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Subpart B--PAYMENT METHODS: GENERAL PROVISIONS
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| Documentation of payment rates. |
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| Encouragement of provider participation. |
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| Public notice of changes in Statewide methods and standards for setting payment rates. |
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| Cost limit for providers operated by units of government. |
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Subpart C--PAYMENT FOR INPATIENT HOSPITAL AND LONG-TERM CARE FACILITY SERVICES
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| Procedures for CMS action on assurances and State plan amendments. |
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| FFP: Conditions relating to institutional reimbursement. |
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| Upper limits based on customary charges. |
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| Inpatient services: Application of upper payment limits. |
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| Hospital providers of NF services (swing-bed hospitals). |
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Subpart D--[RESERVED]
Subpart E--PAYMENT ADJUSTMENTS FOR HOSPITALS THAT SERVE A DISPROPORTIONATE NUMBER OF LOW-INCOME PATIENTS
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| Limitations on aggregate payments for disproportionate share hospitals for the period January 1, 1992 through September 30, 1992. |
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| Limitations on aggregate payments for disproportionate share hospitals beginning October 1, 1992. |
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| State disproportionate share hospital allotments. |
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Subpart F--PAYMENT METHODS FOR OTHER INSTITUTIONAL AND NONINSTITUTIONAL SERVICES
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| Adherence to upper limits; FFP. |
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| Outpatient hospital and clinic services: Application of upper payment limits. |
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| Other inpatient and outpatient facility services: Upper limits of payment. |
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| Upper limits of payment: Nonrisk contract. |
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| Services furnished by rural health clinics. |
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Subparts G-H--[RESERVED]
Subpart I--PAYMENT FOR DRUGS
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| Determination of best price. |
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| Authorized generic drugs. |
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| Exclusion from best price of certain sales at a nominal price. |
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| Requirements for manufacturers. |
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| Drugs: Aggregate upper limits of payment. |
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| Upper limits for multiple source drugs. |
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| Upper limits for drugs furnished as part of services. |
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| State plan requirements, findings and assurances. |
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| FFP: Conditions relating to physician-administered drugs. |
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