[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: 42CFR403.318]



[Page 47-48]

 

                         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. 403.318  Approval of State systems.



    (a) Approval agreement. If CMS approves a State system, a written 

agreement will be executed between CMS and the Chief Executive Officer 

of the State. The agreement must incorporate any terms of the State's 

application for approval of the system as agreed to by the parties and, 

as a minimum, must contain provisions that require the following:

    (1) The system is operated directly by the State or an entity 

designated by State law.

    (2) For purposes of the Medicare program, the State's system applies 

only to Medicare payments for inpatient, and if applicable, outpatient 

hospital services.

    (3) The system conforms to applicable Medicare law and regulations 

other than those relating to the amount of reimbursement for inpatient 

hospital services, or for inpatient and outpatient services, whichever 

the State system covers. Applicable regulations include, for example, 

those describing Medicare benefits and entitlement requirements for 

program beneficiaries, as explained in parts 406 and 409 of this 

chapter; the requirements at part 405, subpart J of this chapter 

specifying conditions of participation for hospitals; the requirements 

at part 405, subparts A, G, and S of this chapter on Medicare program 

administration; and



[[Page 48]]



all applicable fraud and abuse regulations contained in titles 42 and 45 

of the CFR.

    (4) The State must obtain CMS's approval of the State's reporting 

forms and of provider cost reporting forms or other forms that have not 

been approved by CMS but that are necessary for the collection of 

required information.

    (b) Effective date. An approved State system may not be effective 

earlier than the date of the approval agreement, which may not be 

retroactive.