42 CFR 447.15 - Acceptance of State payment as payment in full

Cite as42 CFR 447.15
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110 practice notes
  • Securing Updated and Necessary Statutory Evaluations Timely
    • United States
    • Centers For Medicare And Medicaid Services,Public Health Service,The Inspector General Office
    • Invalid date
    ...of amount, duration, and scope of Medicaid services, found at 42 CFR 440.230-440.250. The Medicaid balanced billing regulation at 42 CFR 447.15. Regulations that shape children's access to care in a wide range of areas, including but not limited to: 42 CFR 438.1-438.930-- Medicaid Managed C......
  • Olszewski v. Scrippshealth, No. D034197.
    • United States
    • California Court of Appeals
    • May 9, 2001
    ..."must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency. . . ." (42 C.F.R. § 447.15.) Therefore, under federal law, ScrippsHealth was eligible for Medi-Cal money only if it agreed to accept the Medi Cal money as payment i......
  • Olszewski v. Scripps Health, No. S098409.
    • United States
    • United States State Supreme Court (California)
    • June 2, 2003
    ...135 Cal.Rptr.2d 13 paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the individual" (42 C.F.R. § 447.15, italics added).8 Section 1396a(a)(25)(C) of title 42 United States Code Service then provides "that in the case of an individual who is......
  • Banks v. Secretary of Indiana Family and Social Services Admin., No. 92-2299
    • United States
    • United States Courts of Appeals. United States Court of Appeals (7th Circuit)
    • June 15, 1993
    ...prohibited from seeking payment from a Medicaid recipient of amounts not reimbursed by the state program. As the Secretary points out, 42 C.F.R. § 447.15 provides that "[a] state plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who acc......
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96 cases
  • Olszewski v. Scrippshealth, No. D034197.
    • United States
    • California Court of Appeals
    • May 9, 2001
    ..."must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency. . . ." (42 C.F.R. § 447.15.) Therefore, under federal law, ScrippsHealth was eligible for Medi-Cal money only if it agreed to accept the Medi Cal money as payment i......
  • Olszewski v. Scripps Health, No. S098409.
    • United States
    • United States State Supreme Court (California)
    • June 2, 2003
    ...135 Cal.Rptr.2d 13 paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the individual" (42 C.F.R. § 447.15, italics added).8 Section 1396a(a)(25)(C) of title 42 United States Code Service then provides "that in the case of an individual who is......
  • Banks v. Secretary of Indiana Family and Social Services Admin., No. 92-2299
    • United States
    • United States Courts of Appeals. United States Court of Appeals (7th Circuit)
    • June 15, 1993
    ...prohibited from seeking payment from a Medicaid recipient of amounts not reimbursed by the state program. As the Secretary points out, 42 C.F.R. § 447.15 provides that "[a] state plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who acc......
  • Ill. Health Maintenance v. Dept. of Ins., No. 1-05-2422.
    • United States
    • Illinois Appellate Court
    • March 5, 2007
    ...The Association argues that the requisite legal prohibition is supplied by federal Medicaid law (42 U.S.C. § 1396a(a)(25)(C) (2000); 42 C.F.R. § 447.15 (2006)) which, according to the Association, bars the Providers in the case at bar from collecting any amount from AHCP enrollees who were ......
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5 firm's commentaries
  • OIG Issues Supplemental Compliance Program Guidance For Nursing Facilities: Quality Of Care Is Top Risk Area
    • United States
    • Mondaq United States
    • October 17, 2008
    ...32 42 U.S.C. 1395nn. 33 Note 1, supra, at p. 56845. 34 Id.; see also 66 Fed. Reg. 856, 923 (January 4, 2001). 35 42 U.S.C. 1395cc(a); 42 CFR 447.15, 36 42 U.S.C. 1395w-101. 37 Note 1, supra, at p. 56846-47. 38 See CMS Survey and Certification Group's May 11, 2006 letter to State Survey Agen......
  • The Supreme Court of Arizona Holds That Hospitals May Not Use Liens Against Third-Party Tortfeasors to Balance Bill Medicaid Patients
    • United States
    • JD Supra United States
    • March 23, 2020
    ...AHCCCS’ reimbursement. Plaintiffs filed the class action lawsuit against the hospitals alleging that 42 U.S.C. § 1396a(a)(25)(C) and 42 C.F.R. § 447.15 (federal Medicaid law and regulations), prohibited hospitals from balance billing patients, or in other words, collecting payments beyond r......
  • Hospitals Cannot Enforce Liens Against AHCCCS Patients’ Third-Party Recoveries
    • United States
    • JD Supra United States
    • April 4, 2018
    ...from enforcing those liens on their tort recoveries. The trial court ruled in favor of the patients, holding that federal regulation – 42 C.F.R. § 447.15 – preempts the hospitals’ state-law statutory lien right. The court prohibited the hospitals from asserting any lien after having receive......
  • Plaintiffs Get to Keep Windfall Damages
    • United States
    • LexBlog United States
    • March 19, 2019
    ...at *1. However, federal law governs the relationship between state Medicaid agencies and the hospitals they contract with. Pursuant to 42 C.F.R. § 447.15, “a state may contract only with providers that agree to ‘accept, as payment in full, the amounts paid by the agency plus any deductible,......
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