[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: 42CFR431.57]



[Page 30]

 

                         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.  431.57  Waiver of cost-sharing requirements.



    (a) Sections 1916(a)(3) and 1916(b)(3) of the Act specify the 

circumstances under which the Secretary is authorized to waive the 

requirement that cost-sharing amounts be nominal.

    (b) For nonemergency services furnished in a hospital emergency 

room, the Secretary may by waiver permit a State to impose a copayment 

of up to double the ``nominal'' copayment amounts determined under Sec.  

447.54(a)(3) of this subchapter.

    (c) Nonemergency services are services that do not meet the 

definition of emergency services at Sec.  447.53(b)(4) of this 

subchapter.

    (d) In order for a waiver to be approved under this section, the 

State must establish to the satisfaction of CMS that alternative sources 

of nonemergency, outpatient services are available and accessible to 

recipients.

    (e) Although, in accordance with Sec.  431.55(b)(3) of this part, a 

waiver will generally be granted for a 2-year duration, CMS will 

reevaluate waivers approved under this section if the State increases 

the nominal copayment amounts in effect when the waiver was approved.

    (f) A waiver approved under this section cannot apply to services 

furnished before the waiver was granted.



[59 FR 4600, Feb. 1, 1994]