TITLE 42 - PUBLIC HEALTH

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER C - MEDICAL ASSISTANCE PROGRAMS

PART 447 - PAYMENTS FOR SERVICES

subpart f - PAYMENT METHODS FOR OTHER INSTITUTIONAL AND NONINSTITUTIONAL SERVICES

447.304 - Adherence to upper limits; FFP.

  (a) The Medicaid agency must not pay more than the upper limits described in this subpart.

  (b) In the case of payments made under the plan for deductibles and coinsurance payable on an assigned Medicare claim for noninstitutional services, those payments may be made only up to the reasonable charge under Medicare.

  (c) FFP is not available for a State's expenditures for services that are in excess of the amounts allowable under this subpart.

Note: The Secretary may waive any limitation on reimbursement imposed by subpart F of this part for experiments conducted under section 402 of Pub. L. 90428, Incentives for Economy Experimentation, as amended by section 222(b) of Pub. L. 92603, and under section 222(a) of Pub. L. 92603.

[46 FR 48560, Oct. 1, 1981; 46 FR 54744, Nov. 4, 1981, as amended at 66 FR 3176, Jan. 12, 2001]