[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: 42CFR438.60]



[Page 221]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 438_MANAGED CARE--Table of Contents

 

                    Subpart B_State Responsibilities

 

Sec.  438.60  Limit on payment to other providers.



    The State agency must ensure that no payment is made to a provider 

other than the MCO, PIHP, or PAHP for services available under the 

contract between the State and the MCO, PIHP, or PAHP, except when these 

payments are provided for in title XIX of the Act, in 42 CFR, or when 

the State agency has adjusted the capitation rates paid under the 

contract, in accordance with Sec.  438.6(c)(5)(v), to make payments for 

graduate medical education.