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.
- § 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.
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.
Subpart C — Payment for Inpatient Hospital and Long-Term Care Facility Services
- § 447.250— Basis and purpose.
- § 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.
- § 447.257— FFP: Conditions relating to institutional reimbursement.
- § 447.271— Upper limits based on customary charges.
- § 447.272— Inpatient services: Application of upper payment limits.
- § 447.280— Hospital providers of NF services (swing-bed hospitals).
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.
- § 447.302— State plan requirements.
- § 447.304— Adherence to upper limits; FFP.
- § 447.321— Outpatient hospital and clinic services: Application of upper payment limits.
- § 447.325— Other inpatient and outpatient facility services: Upper limits of payment.
- § 447.362— Upper limits of payment: Nonrisk contract.
- § 447.371— Services furnished by rural health clinics.
Subpart G — Payments for Primary Care Services Furnished by Physicians
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— Requirement and penalties 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.