Title 42, Part 447 — Payments for Services

Purpose.

Prohibition against reassignment of provider claims.

Acceptance of State payment as payment in full.

Provider restrictions: State plan requirements.

Reduction of payments to providers.

Direct payments to certain beneficiaries for physicians' or dentists' services.

Prohibition on payment for provider-preventable conditions.

Withholding the Federal share of payments to Medicaid providers to recover Medicare overpayments.

Withholding Medicare payments to recover Medicaid overpayments.

Payments for reserving beds in institutions.

Timely claims payment.

Timely claims payment by MCOs.

Premiums and cost sharing: Basis and purpose.

Definitions.

Cost sharing.

Cost sharing for drugs.

Cost sharing for services furnished in a hospital emergency department.

Premiums.

Limitations on premiums and cost sharing.

Beneficiary and public notice requirements.

Options for claiming FFP payment for section 1920A presumptive eligibility medical assistance payments.

FFP: Conditions related to pending investigations of credible allegations of fraud against the Medicaid program.

Basis and purpose.

State plan requirements.

Audits.

Documentation of access to care and service payment rates.

Medicaid provider participation and public process to inform access to care.

Public notice of changes in Statewide methods and standards for setting payment rates.

Basis and purpose.

Definitions.

State plan requirements.

Other requirements.

Related information.

Procedures for CMS action on assurances and State plan amendments.

FFP: Conditions relating to institutional reimbursement.

Upper limits based on customary charges.

Inpatient services: Application of upper payment limits.

Hospital providers of NF services (swing-bed hospitals).

Medicaid disproportionate share hospital (DSH) allotment reductions.

Hospital-specific disproportionate share hospital payment limit: Determination of individuals without health insurance or other third party coverage.

Limitations on aggregate payments for disproportionate share hospitals for the period January 1, 1992 through September 30, 1992.

Limitations on aggregate payments for disproportionate share hospitals beginning October 1, 1992.

State disproportionate share hospital allotments.

Reporting requirements.

Basis and purpose.

State plan requirements.

Adherence to upper limits; FFP.

Outpatient hospital and clinic services: Application of upper payment limits.

Other inpatient and outpatient facility services: Upper limits of payment.

[Reserved]

Upper limits of payment: Nonrisk contract.

Services furnished by rural health clinics.

Primary care services furnished by physicians with a specified specialty or subspecialty.

Amount of required minimum payments.

State plan requirements.

Availability of Federal financial participation (FFP).

Basis and purpose.

Definitions.

Determination of average manufacturer price.

Determination of best price.

Authorized generic drugs.

Identification of inhalation, infusion, instilled, implanted, or injectable drugs (5i drugs).

Exclusion from best price of certain sales at a nominal price.

Medicaid drug rebates (MDR).

Requirement and penalties for manufacturers.

Requirements for States.

Drugs: Aggregate upper limits of payment.

Upper limits for multiple source drugs.

Upper limits for drugs furnished as part of services.

State plan requirements, findings, and assurances.

Federal Financial Participation (FFP): Conditions relating to physician-administered drugs.

Optional coverage of investigational drugs and other drugs not subject to rebate.