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Code of Federal Regulations (Last Updated: November 8, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter C - Medical Assistance Programs |
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Part 447 - Payments for Services |
| 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. |
| Alternative Premiums and Cost Sharing Under Section 1916A |
| § 447.62 - Alternative premiums and cost sharing: Basis, purpose and scope. |
| § 447.64 - Alternative premiums, enrollment fees, or similar fees: State plan requirements. |
| § 447.66 - General alternative premium protections. |
| § 447.68 - Alternative copayments, coinsurance, deductibles, or similar cost sharing charges: State plan requirements. |
| § 447.70 - General alternative cost sharing protections. |
| § 447.71 - Alternative premium and cost sharing exemptions and protections for individuals with family incomes at or below 100 percent of the FPL. |
| § 447.72 - 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. |
| § 447.74 - Alternative premium and cost sharing protections for individuals with family incomes above 150 percent of the FPL. |
| § 447.76 - Public schedule. |
| § 447.78 - Aggregate limits on alternative premiums and cost sharing. |
| § 447.80 - Enforceability of alternative premiums and cost sharing. |
| § 447.82 - Restrictions on payments to providers. |
| federal financial participation |
| § 447.59 - FFP: Conditions relating to cost sharing. |
| § 447.60 - Cost-sharing requirements for services furnished 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. |
| Cost Sharing |
| deductible, coinsurance, co-payment or similar cost-sharing charge |
| § 447.58 - Payments to prepaid capitation organizations. |
| enrollment fee, premium or similar cost sharing charge |
| 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. |
| § 447.206 - Cost limit for providers operated by units of government. |
| § 447.207 - Retention of payments. |
| Subpart C - Payment for Inpatient Hospital and Long-Term Care Facility Services |
| § 447.250 - Basis and purpose. |
| 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). |
| 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. |
| Subpart D - XXX |
| 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. |
| Subpart F - Payment Methods for Other Institutional and Noninstitutional Services |
| § 447.300 - Basis and purpose. |
| § 447.301 - Definitions. |
| § 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 |
| § 447.361 - Upper limits of payment: Risk contract. |
| § 447.362 - Upper limits of payment: Nonrisk contract. |
| Drugs |
| § 447.331 - Drugs: Aggregate upper limits of payment. |
| § 447.332 - Upper limits for multiple source drugs. |
| § 447.333 - State plan requirements, findings and assurances. |
| § 447.334 - Upper limits for drugs furnished as part of services. |
| Rural Health Clinic Services |
| § 447.371 - Services furnished by rural health clinics. |
| 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). |
| Subpart H - XXX |
| 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. |
| §§ 447.500--447.532 - [Reserved] |
| § 447.534 - Manufacturer reporting requirements. |
| §§ 447.536--447.550 - [Reserved] |