[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR431.52]



[Page 26]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 431_STATE ORGANIZATION AND GENERAL ADMINISTRATION--Table of Contents

 

              Subpart B_General Administrative Requirements

 

Sec.  431.52  Payments for services furnished out of State.



    (a) Statutory basis. Section 1902(a)(16) of the Act authorizes the 

Secretary to prescribe State plan requirements for furnishing Medicaid 

to State residents who are absent from the State.

    (b) Payment for services. A State plan must provide that the State 

will pay for services furnished in another State to the same extent that 

it would pay for services furnished within its boundaries if the 

services are furnished to a recipient who is a resident of the State, 

and any of the following conditions is met:

    (1) Medical services are needed because of a medical emergency;

    (2) Medical services are needed and the recipient's health would be 

endangered if he were required to travel to his State of residence;

    (3) The State determines, on the basis of medical advice, that the 

needed medical services, or necessary supplementary resources, are more 

readily available in the other State;

    (4) It is general practice for recipients in a particular locality 

to use medical resources in another State.

    (c) Cooperation among States. The plan must provide that the State 

will establish procedures to facilitate the furnishing of medical 

services to individuals who are present in the State and are eligible 

for Medicaid under another State's plan.