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Electronic Code of Federal Regulations

e-CFR data is current as of January 22, 2020

Title 42Chapter IVSubchapter CPart 447


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS

PART 447—PAYMENTS FOR SERVICES

rule

Subpart A—PAYMENTS: GENERAL PROVISIONS

§447.1
Purpose.
§447.10
Prohibition against reassignment of provider claims.
§447.15
Acceptance of State payment as payment in full.
§447.20
Provider restrictions: State plan requirements.
§447.21
Reduction of payments to providers.
§447.25
Direct payments to certain beneficiaries for physicians' or dentists' services.
§447.26
Prohibition on payment for provider-preventable conditions.
§447.30
Withholding the Federal share of payments to Medicaid providers to recover Medicare overpayments.
§447.31
Withholding Medicare payments to recover Medicaid overpayments.
§447.40
Payments for reserving beds in institutions.
§447.45
Timely claims payment.
§447.46
Timely claims payment by MCOs.

Medicaid Premiums and Cost Sharing

§447.50
Premiums and cost sharing: Basis and purpose.
§447.51
Definitions.
§447.52
Cost sharing.
§447.53
Cost sharing for drugs.
§447.54
Cost sharing for services furnished in a hospital emergency department.
§447.55
Premiums.
§447.56
Limitations on premiums and cost sharing.
§447.57
Beneficiary and public notice requirements.
§447.88
Options for claiming FFP payment for section 1920A presumptive eligibility medical assistance payments.
§447.90
FFP: Conditions related to pending investigations of credible allegations of fraud against the Medicaid program.
rule

Subpart B—PAYMENT METHODS: GENERAL PROVISIONS

§447.200
Basis and purpose.
§447.201
State plan requirements.
§447.202
Audits.
§447.203
Documentation of access to care and service payment rates.
§447.204
Medicaid provider participation and public process to inform access to care.
§447.205
Public notice of changes in Statewide methods and standards for setting payment rates.
rule

Subpart C—PAYMENT FOR INPATIENT HOSPITAL AND LONG-TERM CARE FACILITY SERVICES

§447.250
Basis and purpose.

Payment Rates

§447.251
Definitions.
§447.252
State plan requirements.
§447.253
Other requirements.
§447.255
Related information.
§447.256
Procedures for CMS action on assurances and State plan amendments.

Federal Financial Participation

§447.257
FFP: Conditions relating to institutional reimbursement.

Upper Limits

§447.271
Upper limits based on customary charges.
§447.272
Inpatient services: Application of upper payment limits.

Swing-Bed Hospitals

§447.280
Hospital providers of NF services (swing-bed hospitals).
rule

Subpart D—[RESERVED]

rule

Subpart E—PAYMENT ADJUSTMENTS FOR HOSPITALS THAT SERVE A DISPROPORTIONATE NUMBER OF LOW-INCOME PATIENTS

§447.294
Medicaid disproportionate share hospital (DSH) allotment reductions.
§447.295
Hospital-specific disproportionate share hospital payment limit: Determination of individuals without health insurance or other third party coverage.
§447.296
Limitations on aggregate payments for disproportionate share hospitals for the period January 1, 1992 through September 30, 1992.
§447.297
Limitations on aggregate payments for disproportionate share hospitals beginning October 1, 1992.
§447.298
State disproportionate share hospital allotments.
§447.299
Reporting requirements.
rule

Subpart F—PAYMENT METHODS FOR OTHER INSTITUTIONAL AND NONINSTITUTIONAL SERVICES

§447.300
Basis and purpose.
§447.302
State plan requirements.
§447.304
Adherence to upper limits; FFP.

Outpatient Hospital and Clinic Services

§447.321
Outpatient hospital and clinic services: Application of upper payment limits.

Other Inpatient and Outpatient Facilities

§447.325
Other inpatient and outpatient facility services: Upper limits of payment.
§447.342
[Reserved]

Prepaid Capitation Plans

§447.362
Upper limits of payment: Nonrisk contract.

Rural Health Clinic Services

§447.371
Services furnished by rural health clinics.
rule

Subpart G—PAYMENTS FOR PRIMARY CARE SERVICES FURNISHED BY PHYSICIANS

§447.400
Primary care services furnished by physicians with a specified specialty or subspecialty.
§447.405
Amount of required minimum payments.
§447.410
State plan requirements.
§447.415
Availability of Federal financial participation (FFP).
rule

Subpart H—[RESERVED]

rule

Subpart I—PAYMENT FOR DRUGS

§447.500
Basis and purpose.
§447.502
Definitions.
§447.504
Determination of average manufacturer price.
§447.505
Determination of best price.
§447.506
Authorized generic drugs.
§447.507
Identification of inhalation, infusion, instilled, implanted, or injectable drugs (5i drugs).
§447.508
Exclusion from best price of certain sales at a nominal price.
§447.509
Medicaid drug rebates (MDR).
§447.510
Requirements for manufacturers.
§447.511
Requirements for States.
§447.512
Drugs: Aggregate upper limits of payment.
§447.514
Upper limits for multiple source drugs.
§447.516
Upper limits for drugs furnished as part of services.
§447.518
State plan requirements, findings, and assurances.
§447.520
Federal Financial Participation (FFP): Conditions relating to physician-administered drugs.
§447.522
Optional coverage of investigational drugs and other drugs not subject to rebate.

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