42 C.F.R. § 447.15
Acceptance of State payment as payment in full
A State plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the individual. The provider may only deny services to any eligible individual on account of the individual's inability to pay the cost sharing amount imposed by the plan in accordance with § 447.52(e). The previous sentence does not apply to an individual who is able to pay. An individual's inability to pay does not eliminate his or her liability for the cost sharing charge.
Notes of Decisions
Cited in 110
cases (19 in the last 5 years), 1979–2026 · leading case: Keup v. Wisconsin Dep't of Health & Fam. Servs., 2004 WI 16 (Wis. 2004).
Keup v. Wisconsin Dep't of Health & Fam. Servs., 2004 WI 16 (Wis. 2004). “Finally, Keup argues that DHFS violated 42 C.F.R. § 447.15 , [16] the "payment in full" provision, as Mequon did not accept DHFS' payment as payment in full and, instead, retained the difference between DHFS' payment and the amount paid by Keup upon her admission to Mequon.”
Illinois Health Maint. Org. Guar. Ass'n v. Dep't of Ins., 864 N.E.2d 798 (Ill. App. Ct. 2007). “This second limitation applies to providers that, "as a matter of law[,] * * * may not seek payment from the enrollee for services provided to such enrollee." 215 ILCS 125/6-8(8)(b)(ii) (West 2004).”
Ansley v. Banner Health, 437 P.3d 899 (Ariz. Ct. App. 2019). “¶15 The Patients argue the Hospitals' liens are invalid under 42 C.F.R. § 447.15 , a federal regulation issued in 1980.”
Starko, Inc. v. Presbyterian Health Plan, 276 P.3d 252 (N.M. Ct. App. 2011). “" The Medicaid Payment for Services Rule, 42 C.F.R. § 447.15 , provides that participation in the Medicaid program is limited to providers that "accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be…”
Jackie Abbott v. Banner Health Network, 372 P.3d 933 (Ariz. 2016). “And pursuant to 42 C.F.R. § 447.15 : A State plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan…”
Smallwood v. Cent. Peninsula Gen. Hosp., 151 P.3d 319 (Alaska 2006). “2005); 42 C.F.R. § 447.15 (2005) ("A State plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan…”
Starko, Inc. v. Presbyterian Health Plan, Inc., 2012 NMCA 053 (N.M. Ct. App. 2012). “” The Medicaid Payment for Services Rule, 42 C.F.R. § 447.15 , provides that participation in the Medicaid program is limited to providers that “accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be…”
Olszewski v. Scripps Health, 69 P.3d 927 (Cal. 2003). “181, 182 ), "[a] State plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts *13 paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the…”
Stevens Ex Rel. Stevens v. Indiana Dep't of Pub. Welfare, 566 N.E.2d 544 (Ind. Ct. App. 1991). “42 C.F.R. 447.15. (i) A Medicaid provider shall not collect from a Medicaid recipient or from the family of the Medicaid recipient any portion of his charge for a Medicaid covered service which is not reimbursed by the Indiana Medicaid program, except for co-payment and any…”
Auto-Owners Ins. Co. v. Compass Healthcare Plc, 928 N.W.2d 726 (Mich. Ct. App. 2018). “”); 42 CFR 447.15 (“A State plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by…”
Walter Ansley v. Banner Health Network, 459 P.3d 55 (Ariz. 2020). “§ 1396a(a)(25)(C) and 42 C.F.R. § 447.15 . The regulation, which implements the statute, provides that state Medicaid plans must limit participation to “providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment…”
Baptist Healthcare Sys., Inc. v. Miller, 177 S.W.3d 676 (Ky. 2005). “42 C.F.R. § 447.15 . Thus, cases addressing the issue in the context of Medicaid "charges" versus actual payments are equally relevant to this issue.”
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