Title 42

PART 447

Part 447 - Payments For Services

PART 447 - PAYMENTS FOR SERVICES Authority:42 U.S.C. 1302 and 1396r-8. Source:43 FR 45253, Sept. 29, 1978, unless otherwise noted.

42:4.0.1.1.12.1SUBPART A
Subpart A - Payments: General Provisions
42:4.0.1.1.12.1.109SUBJGRP 109
   Medicaid Premiums and Cost Sharing
42:4.0.1.1.12.1.109.1SECTION 447.1
   447.1 Purpose.
42:4.0.1.1.12.1.109.2SECTION 447.10
   447.10 Prohibition against reassignment of provider claims.
42:4.0.1.1.12.1.109.3SECTION 447.15
   447.15 Acceptance of State payment as payment in full.
42:4.0.1.1.12.1.109.4SECTION 447.20
   447.20 Provider restrictions: State plan requirements.
42:4.0.1.1.12.1.109.5SECTION 447.21
   447.21 Reduction of payments to providers.
42:4.0.1.1.12.1.109.6SECTION 447.25
   447.25 Direct payments to certain beneficiaries for physicians' or dentists' services.
42:4.0.1.1.12.1.109.7SECTION 447.26
   447.26 Prohibition on payment for provider-preventable conditions.
42:4.0.1.1.12.1.109.8SECTION 447.30
   447.30 Withholding the Federal share of payments to Medicaid providers to recover Medicare overpayments.
42:4.0.1.1.12.1.109.9SECTION 447.31
   447.31 Withholding Medicare payments to recover Medicaid overpayments.
42:4.0.1.1.12.1.109.10SECTION 447.40
   447.40 Payments for reserving beds in institutions.
42:4.0.1.1.12.1.109.11SECTION 447.45
   447.45 Timely claims payment.
42:4.0.1.1.12.1.109.12SECTION 447.46
   447.46 Timely claims payment by MCOs.
42:4.0.1.1.12.1.109.13SECTION 447.50
   447.50 Premiums and cost sharing: Basis and purpose.
42:4.0.1.1.12.1.109.14SECTION 447.51
   447.51 Definitions.
42:4.0.1.1.12.1.109.15SECTION 447.52
   447.52 Cost sharing.
42:4.0.1.1.12.1.109.16SECTION 447.53
   447.53 Cost sharing for drugs.
42:4.0.1.1.12.1.109.17SECTION 447.54
   447.54 Cost sharing for services furnished in a hospital emergency department.
42:4.0.1.1.12.1.109.18SECTION 447.55
   447.55 Premiums.
42:4.0.1.1.12.1.109.19SECTION 447.56
   447.56 Limitations on premiums and cost sharing.
42:4.0.1.1.12.1.109.20SECTION 447.57
   447.57 Beneficiary and public notice requirements.
42:4.0.1.1.12.1.109.21SECTION 447.88
   447.88 Options for claiming FFP payment for section 1920A presumptive eligibility medical assistance payments.
42:4.0.1.1.12.1.109.22SECTION 447.90
   447.90 FFP: Conditions related to pending investigations of credible allegations of fraud against the Medicaid program.
42:4.0.1.1.12.2SUBPART B
Subpart B - Payment Methods: General Provisions
42:4.0.1.1.12.2.110.1SECTION 447.200
   447.200 Basis and purpose.
42:4.0.1.1.12.2.110.2SECTION 447.201
   447.201 State plan requirements.
42:4.0.1.1.12.2.110.3SECTION 447.202
   447.202 Audits.
42:4.0.1.1.12.2.110.4SECTION 447.203
   447.203 Documentation of access to care and service payment rates.
42:4.0.1.1.12.2.110.5SECTION 447.204
   447.204 Medicaid provider participation and public process to inform access to care.
42:4.0.1.1.12.2.110.6SECTION 447.205
   447.205 Public notice of changes in Statewide methods and standards for setting payment rates.
42:4.0.1.1.12.3SUBPART C
Subpart C - Payment for Inpatient Hospital and Long-Term Care Facility Services
42:4.0.1.1.12.3.110SUBJGRP 110
   Payment Rates
42:4.0.1.1.12.3.110.1SECTION 447.250
   447.250 Basis and purpose.
42:4.0.1.1.12.3.110.2SECTION 447.251
   447.251 Definitions.
42:4.0.1.1.12.3.110.3SECTION 447.252
   447.252 State plan requirements.
42:4.0.1.1.12.3.110.4SECTION 447.253
   447.253 Other requirements.
42:4.0.1.1.12.3.110.5SECTION 447.255
   447.255 Related information.
42:4.0.1.1.12.3.110.6SECTION 447.256
   447.256 Procedures for CMS action on assurances and State plan amendments.
42:4.0.1.1.12.3.111SUBJGRP 111
   Federal Financial Participation
42:4.0.1.1.12.3.111.7SECTION 447.257
   447.257 FFP: Conditions relating to institutional reimbursement.
42:4.0.1.1.12.3.112SUBJGRP 112
   Upper Limits
42:4.0.1.1.12.3.112.8SECTION 447.271
   447.271 Upper limits based on customary charges.
42:4.0.1.1.12.3.112.9SECTION 447.272
   447.272 Inpatient services: Application of upper payment limits.
42:4.0.1.1.12.3.113SUBJGRP 113
   Swing-Bed Hospitals
42:4.0.1.1.12.3.113.10SECTION 447.280
   447.280 Hospital providers of NF services (swing-bed hospitals).
42:4.0.1.1.12.4SUBPART D
Subpart D [Reserved]
42:4.0.1.1.12.5SUBPART E
Subpart E - Payment Adjustments for Hospitals That Serve a Disproportionate Number of Low-Income Patients
42:4.0.1.1.12.5.114.1SECTION 447.294
   447.294 Medicaid disproportionate share hospital (DSH) allotment reductions.
42:4.0.1.1.12.5.114.2SECTION 447.295
   447.295 Hospital-specific disproportionate share hospital payment limit: Determination of individuals without health insurance or other third party coverage.
42:4.0.1.1.12.5.114.3SECTION 447.296
   447.296 Limitations on aggregate payments for disproportionate share hospitals for the period January 1, 1992 through September 30, 1992.
42:4.0.1.1.12.5.114.4SECTION 447.297
   447.297 Limitations on aggregate payments for disproportionate share hospitals beginning October 1, 1992.
42:4.0.1.1.12.5.114.5SECTION 447.298
   447.298 State disproportionate share hospital allotments.
42:4.0.1.1.12.5.114.6SECTION 447.299
   447.299 Reporting requirements.
42:4.0.1.1.12.6SUBPART F
Subpart F - Payment Methods for Other Institutional and Noninstitutional Services
42:4.0.1.1.12.6.114SUBJGRP 114
   Outpatient Hospital and Clinic Services
42:4.0.1.1.12.6.114.1SECTION 447.300
   447.300 Basis and purpose.
42:4.0.1.1.12.6.114.2SECTION 447.302
   447.302 State plan requirements.
42:4.0.1.1.12.6.114.3SECTION 447.304
   447.304 Adherence to upper limits; FFP.
42:4.0.1.1.12.6.114.4SECTION 447.321
   447.321 Outpatient hospital and clinic services: Application of upper payment limits.
42:4.0.1.1.12.6.115SUBJGRP 115
   Other Inpatient and Outpatient Facilities
42:4.0.1.1.12.6.115.5SECTION 447.325
   447.325 Other inpatient and outpatient facility services: Upper limits of payment.
42:4.0.1.1.12.6.115.6SECTION 447.342
   447.342 [Reserved]
42:4.0.1.1.12.6.116SUBJGRP 116
   Prepaid Capitation Plans
42:4.0.1.1.12.6.116.7SECTION 447.362
   447.362 Upper limits of payment: Nonrisk contract.
42:4.0.1.1.12.6.117SUBJGRP 117
   Rural Health Clinic Services
42:4.0.1.1.12.6.117.8SECTION 447.371
   447.371 Services furnished by rural health clinics.
42:4.0.1.1.12.7SUBPART G
Subpart G - Payments for Primary Care Services Furnished by Physicians
42:4.0.1.1.12.7.118.1SECTION 447.400
   447.400 Primary care services furnished by physicians with a specified specialty or subspecialty.
42:4.0.1.1.12.7.118.2SECTION 447.405
   447.405 Amount of required minimum payments.
42:4.0.1.1.12.7.118.3SECTION 447.410
   447.410 State plan requirements.
42:4.0.1.1.12.7.118.4SECTION 447.415
   447.415 Availability of Federal financial participation (FFP).
42:4.0.1.1.12.8SUBPART H
Subpart H [Reserved]
42:4.0.1.1.12.9SUBPART I
Subpart I - Payment for Drugs
42:4.0.1.1.12.9.118.1SECTION 447.500
   447.500 Basis and purpose.
42:4.0.1.1.12.9.118.2SECTION 447.502
   447.502 Definitions.
42:4.0.1.1.12.9.118.3SECTION 447.504
   447.504 Determination of average manufacturer price.
42:4.0.1.1.12.9.118.4SECTION 447.505
   447.505 Determination of best price.
42:4.0.1.1.12.9.118.5SECTION 447.506
   447.506 Authorized generic drugs.
42:4.0.1.1.12.9.118.6SECTION 447.507
   447.507 Identification of inhalation, infusion, instilled, implanted, or injectable drugs (5i drugs).
42:4.0.1.1.12.9.118.7SECTION 447.508
   447.508 Exclusion from best price of certain sales at a nominal price.
42:4.0.1.1.12.9.118.8SECTION 447.509
   447.509 Medicaid drug rebates (MDR).
42:4.0.1.1.12.9.118.9SECTION 447.510
   447.510 Requirements for manufacturers.
42:4.0.1.1.12.9.118.10SECTION 447.511
   447.511 Requirements for States.
42:4.0.1.1.12.9.118.11SECTION 447.512
   447.512 Drugs: Aggregate upper limits of payment.
42:4.0.1.1.12.9.118.12SECTION 447.514
   447.514 Upper limits for multiple source drugs.
42:4.0.1.1.12.9.118.13SECTION 447.516
   447.516 Upper limits for drugs furnished as part of services.
42:4.0.1.1.12.9.118.14SECTION 447.518
   447.518 State plan requirements, findings, and assurances.
42:4.0.1.1.12.9.118.15SECTION 447.520
   447.520 Federal Financial Participation (FFP): Conditions relating to physician-administered drugs.
42:4.0.1.1.12.9.118.16SECTION 447.522
   447.522 Optional coverage of investigational drugs and other drugs not subject to rebate.