[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR403.310]



[Page 46-47]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 403_SPECIAL PROGRAMS AND PROJECTS--Table of Contents

 

      Subpart C_Recognition of State Reimbursement Control Systems

 

Sec. 403.310  Reduction in payments.



    (a) General rule. If CMS determines that the satisfactory assurances 

required of a State under Sec. 403.304(c) and, if applicable, Sec. 

403.304(d) have not been met, or will not be met, with respect to any 

36-month period, CMS will reduce Medicare payments to individual 

hospitals being reimbursed under the State's system or, if applicable, 

under the Medicare payment system, in an amount equal to the amount by 

which the Medicare payments under the system exceed the amount of 

Medicare payments to such hospitals that otherwise would have been made 

not using the State system. The amount of the recoupment will include, 

when appropriate, interest charges computed in accordance with Sec. 

405.378 of this chapter.

    (b) Recoupment procedures. The amount of the overpayment will be 

recouped on a proportionate basis from each of those hospitals that 

received payments under the State system that exceeded the payments they 

would



[[Page 47]]



have received under the Medicare payment system. Each hospital's share 

of the aggregate excess payment will be determined on the basis of a 

comparison of the hospital's proportionate share of the aggregate 

payment received under the State system that is in excess of what the 

aggregate payment would have been under the Medicare payment system. 

Recoupments may be accomplished by a hospital's direct payment to the 

Medicare program or by offsets to future payments made to the hospital.

    (c) Alternative recoupment procedures. As an alternative to the 

recoupment procedures described in paragraph (b) of this section and 

subject to CMS's acceptance, the State may provide, by legislation or 

legally binding regulations, procedures for the recoupment of the amount 

of payments that exceed the amount of payments that otherwise would have 

been paid by Medicare if the State system had not been in effect.

    (d) Rule for existing Medicare demonstration projects. In cases of 

existing Medicare demonstration projects where the expenditure test is 

to be applied by a rate of increase factor, the amount of the excess 

payment will be determined, for the three hospital cost reporting 

periods beginning before October 1, 1986, by a comparison of the State 

system's rate of increase to the national rate of increase. Recoupment 

of excessive payments will be assessed and recouped as described in this 

section.



[51 FR 15492, Apr. 24, 1986, as amended at 61 FR 63748, Dec. 2, 1996]