[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: 42CFR447.25]



[Page 308-309]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 447_PAYMENTS FOR SERVICES--Table of Contents

 

                 Subpart A_Payments: General Provisions

 

Sec.  447.25  Direct payments to certain recipients for physicians' or 



dentists' services.



    (a) Basis and purpose. This section implements section 1905(a) of 

the Act by prescribing requirements applicable to States making direct 

payments to certain recipients for physicians' or dentists' services.

    (b) State plan requirements. Except for groups specified in 

paragraph (c) of this section, a State may make direct payments to 

recipients for physicians' or dentists' services. If it does so, the 

State plan must--

    (1) Provide for direct payments; and

    (2) Specify the conditions under which payments are made.

    (c) Federal financial participation. No FFP is available in 

expenditures for direct payment for physicians' or dentists' services to 

any recipient--

    (1) Who is receiving assistance under the State's approved plan 

under title I, IV-A, X, XIV or XVI (AABD) of the Act; or



[[Page 309]]



    (2) To whom supplemental security benefits are being paid under 

title XVI of the Act; or

    (3) Who is receiving or eligible for a State supplementary payment 

or would be eligible if he were not in a medical institution, and who is 

eligible for Medicaid as a categorically needy recipient.

    (d) Federal requirements. (1) Direct payments to recipients under 

this section are an alternative to payments directly to providers and 

are subject to the same conditions; for example, the State's reasonable 

charge schedules are applicable.

    (2) Direct payments must be supported by providers' bills for 

services.