United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2007_register executive 2010-09-22 article Part V Rules and Regulations D09002ee1c80af536 D09002ee1c80af644 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency This regulation clarifies that entities involved in the financing of the non-Federal share of Medicaid payments must be a unit of government; clarifies the documentation required to support a Medicaid certified public expenditure; limits Medicaid reimbursement for health care providers that are operated by units of government to an amount that does not exceed the health care provider's cost of providing services to Medicaid individuals; requires all health care providers to receive and retain the full amount of total computable payments for services furnished under the approved Medicaid State plan; and makes conforming changes to provisions governing the State Child Health Insurance Program (SCHIP) to make the same requirements applicable, with the exception of the cost limit on reimbursement. The Medicaid cost limit provision of this regulation does not apply to: Stand-alone SCHIP program payments made to governmentally-operated health care providers; Indian Health Service (IHS) facilities and tribal 638 facilities that are paid at the all-inclusive IHS rate; Medicaid Managed Care Organizations (MCOs), Prepaid Inpatient Health Plans (PIHPs), and Prepaid Ambulatory Health Plans (PAHPs); Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Moreover, disproportionate share hospital (DSH) payments and payments authorized under Section 701(d) and Section 705 of the Benefits Improvement Protection Act of 2000 are not subject to the newly established Medicaid cost limit for governmentally-operated health care providers. Except as noted above, all Medicaid payments and SCHIP payments made under the authority of the State plan and under waiver and demonstration authorities, as well as associated State Medicaid and SCHIP financing arrangements, are subject to all provisions of this regulation. Finally, this regulation solicits comments from the public on issues related to the definition of the Unit of Government. 72 FR 29748 https://www.govinfo.gov/app/details/FR-2007-05-29/07-2657 07-2657 fr29my07-7 RIN 0938-A057 4120-01-P CMS-2258-FC https://www.govinfo.gov/app/details/FR-2007-05-29/07-2657 https://www.govinfo.gov/content/pkg/FR-2007-05-29/html/07-2657.htm https://www.govinfo.gov/content/pkg/FR-2007-05-29/pdf/07-2657.pdf Administrative Practice and Procedure Child Support Claims Grant Programs-Health Medicaid Reporting and Recordkeeping Requirements Accounting Administrative Practice and Procedure Drugs Health Facilities Health Professions Medicaid Reporting and Recordkeeping Requirements Rural Areas Health Insurance 89 p. 29748 29836 72 FR 29748 Title 42 Part 433 42 CFR Part 433 Title 42 Part 447 42 CFR Part 447 Title 42 Part 457 42 CFR Part 457 RIN 0938-A057 Medicaid Program; Cost Limit for Providers Operated by Units of Government and Provisions To Ensure the Integrity of Federal-State Financial Partnership; Federal Register Vol. 72, Issue RULE 07-2657 V DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2007-07-30 CMS-2258-FC 4120-01-P 07-2657 Final rule with comment period.

This regulation clarifies that entities involved in the financing of the non-Federal share of Medicaid payments must be a unit of government; clarifies the documentation required to support a Medicaid certified public expenditure; limits Medicaid reimbursement for health care providers that are operated by units of government to an amount that does not exceed the health care provider's cost of providing services to Medicaid individuals; requires all health care providers to receive and retain the full amount of total computable payments for services furnished under the approved Medicaid State plan; and makes conforming changes to provisions governing the State Child Health Insurance Program (SCHIP) to make the same requirements applicable, with the exception of the cost limit on reimbursement. The Medicaid cost limit provision of this regulation does not apply to: Stand-alone SCHIP program payments made to governmentally-operated health care providers; Indian Health Service (IHS) facilities and tribal 638 facilities that are paid at the all-inclusive IHS rate; Medicaid Managed Care Organizations (MCOs), Prepaid Inpatient Health Plans (PIHPs), and Prepaid Ambulatory Health Plans (PAHPs); Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Moreover, disproportionate share hospital (DSH) payments and payments authorized under Section 701(d) and Section 705 of the Benefits Improvement Protection Act of 2000 are not subject to the newly established Medicaid cost limit for governmentally-operated health care providers. Except as noted above, all Medicaid payments and SCHIP payments made under the authority of the State plan and under waiver and demonstration authorities, as well as associated State Medicaid and SCHIP financing arrangements, are subject to all provisions of this regulation. Finally, this regulation solicits comments from the public on issues related to the definition of the Unit of Government.

Effective Dates: This regulation is effective on July 30, 2007. Aaron Blight, (410) 786-9560. Administrative Practice and Procedure Child Support Claims Grant Programs-Health Medicaid Reporting and Recordkeeping Requirements Accounting Administrative Practice and Procedure Drugs Health Facilities Health Professions Medicaid Reporting and Recordkeeping Requirements Rural Areas Health Insurance Medicaid: Federal-State financial partnership integrity and cost limit provisions for governmentally-operated health care providers, Katherine_T._Astrich@omb.eop.go http://www.access.gpo.gov/nara/index.html http://www.cms.hhs.gov/eRulemaking http://www.cms.hhs.gov/MedicaidGenInfo/Downloads/Cost http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf Vol. 72, no. 102 Office of the Federal Register, National Archives and Records Administration 2007-05-29 continuing daily deposited born digital 420 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2007-05-29 P0b002ee180965db8 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr29my07 https://www.govinfo.gov/app/details/FR-2007-05-29 https://www.govinfo.gov/content/pkg/FR-2007-05-29/pdf/FR-2007-05-29.pdf https://www.govinfo.gov/content/pkg/FR-2007-05-29/xml/FR-2007-05-29.xml fdlp 29429 29836 DGPO 2010-09-22 2024-06-05 FR-2007-05-29 machine generated eng FR FR-2007-05-29 72 102