[Code of Federal Regulations]
[Title 42, Volume 3]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR447.20]

[Page 288-289]
 
                         TITLE 42--PUBLIC HEALTH
 
  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 
                 HEALTH AND HUMAN SERVICES--(Continued)
 
PART 447--PAYMENTS FOR SERVICES--Table of Contents
 
                 Subpart A--Payments: General Provisions
 
Sec. 447.20  Provider restrictions: State plan requirements.

    A State plan must provide for the following:
    (a) In the case of an individual who is eligible for medical 
assistance under the plan for service(s) for which a third party or 
parties is liable for payment, if the total amount of the established 
liability of the third party or parties for the service is--
    (1) Equal to or greater than the amount payable under the State plan 
(which includes, when applicable, cost-sharing payments provided for in 
Secs. 447.53 through 447.56), the provider furnishing the service to the 
individual may not seek to collect from the individual (or any 
financially responsible relative or representative of that individual) 
any payment amount for that service; or
    (2) Less than the amount payable under the State plan (including 
cost sharing payments set forth in Secs. 447.53 through 447.56), the 
provider furnishing the service to that individual may collect from the 
individual (or any financially responsible relative or representative of 
the individual) an amount which is the lesser of--
    (i) Any cost-sharing payment amount imposed upon the individual 
under Secs. 447.53 through 447.56; or
    (ii) An amount which represents the difference between the amount 
payable under the State plan (which includes, where applicable, cost-
sharing payments provided for in Secs. 447.53 through 447.56) and the 
total of the established third party liability for the services.
    (b) A provider may not refuse to furnish services covered under the 
plan to

[[Page 289]]

an individual who is eligible for medical assistance under the plan on 
account of a third party's potential liability for the service(s).

[55 FR 1433, Jan. 16, 1990]