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]