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Title 42: Public Health
CHAPTER IV: CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)
SUBCHAPTER D: STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs)
PART 457: ALLOTMENTS AND GRANTS TO STATES
Subpart B: General Administration-Reviews and Audits; Withholding for Failure to Comply; Deferral and Disallowance of Claims; Reduction of Federal Medical Payments
457.224 - FFP: Conditions relating to cost sharing.
(a) No FFP is available for the following amounts, even when related to services or benefit coverage which is or could be provided under a State CHIP program?
(1) Any cost sharing amounts that beneficiaries should have paid as enrollment fees, premiums, deductibles, coinsurance, copayments, or similar charges.
(2) Any amounts paid by the agency for health benefits coverage or services furnished to individuals who would not be eligible for that coverage or those services under the approved State child health plan, whether or not the individual paid any required premium or enrollment fee.
(b) The amount of expenditures under the State child health plan must be reduced by the amount of any premiums and other cost-sharing received by the State.
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