(a) When notice is required. Except as specified in paragraph (b) of this section, the agency must provide public notice of any significant proposed change in its methods and standards for setting payment rates for services.
(b) When notice is not required. Notice is not required if—
(1) The change is being made to conform to Medicare methods or levels of reimbursement;
(2) The change is required by court order; or
(3) The change is based on changes in wholesalers' or manufacturers' prices of drugs or materials, if the agency's reimbursement system is based on material cost plus a professional fee.
(c) Content of notice. The notice must—
(1) Describe the proposed change in methods and standards;
(2) Give an estimate of any expected increase or decrease in annual aggregate expenditures;
(3) Explain why the agency is changing its methods and standards;
(4) Identify a local agency in each county (such as the social services agency or health department) where copies of the proposed changes are available for public review;
(5) Give an address where written comments may be sent and reviewed by the public; and
(6) If there are public hearings, give the location, date and time for hearings or tell how this information may be obtained.
(d) Publication of notice. The notice must—
(1) Be published before the proposed effective date of the change; and
(2) Appear as a public announcement in one of the following publications:
(i) A State register similar to the Federal Register.
(ii) The newspaper of widest circulation in each city with a population of 50,000 or more.
(iii) The newspaper of widest circulation in the State, if there is no city with a population of 50,000 or more.
(iv) A Web site developed and maintained by the single State agency or other responsible State agency that is accessible to the general public, provided that the Web site:
(A) Is clearly titled and can be easily reached from a hyperlink included on Web sites that provide general information to beneficiaries and providers, and included on the State-specific page on the Federal Medicaid Web site.
(B) Is updated for bulletins on a regular and known basis (for example, the first day of each month), and the public notice is issued as part of the regular update;
(C) Includes the actual date it was released to the public on the Web site; or
(D) Complies with national standards to ensure access to individuals with disabilities; and
(E) Includes protections to ensure that the content of the issued notice is not modified after the initial publication and is maintained on the Web site for no less than a 3-year period.
[46 FR 58680, Dec. 3, 1981; 47 FR 8567, Mar. 1, 1982, as amended at 48 FR 56057, Dec. 19, 1983; 80 FR 67612, Nov. 2, 2015]
Notes of Decisions
Christ the King Manor, Inc. v. Sec'y United States Dep't of Health & Human Servs., 730 F.3d 291 (3rd Cir. 2013).
· cites it 3× “Under 42 C.F.R. § 447.205 , notice of a “significant proposed change” in a state’s rate-setting methodology must “[d]escribe the proposed change in methods and standards,” “[g]ive an estimate of any expected increase or decrease in annual aggregate expenditures,” “[ejxplain why…”
Indep. Acceptance Co. v. California, 204 F.3d 1247 (9th Cir. 2000).
· cites it 14× “Finally, Plaintiffs maintain that the change in the effective date for SPA 90-20B from October 1, 1990, to August 1, 1991, constituted a “significant proposed change” requiring new notice pursuant to 42 C.F.R. § 447.205 (a) (1997). Plaintiffs argue that, as a result, the…”
Massachusetts Hosp. Ass'n v. Dep't of Pub. Welfare, 419 Mass. 644 (Mass. 1995).
· cites it 6× “On March 13, 1992, HCFA disapproved the department’s first proposed amendment, TN90-19, because of the State’s failure to publish a public notice of the amendment, in compliance with 42 C.F.R. § 447.205 . HCFA approved the second proposed amendment, TN90-24, but set an effective…”
Morabito v. Blum, 528 F. Supp. 252 (S.D.N.Y. 1981).
· cites it 3× “The federal public notice requirement relied on by plaintiffs is contained in 42 C.F.R. § 447.205 (“Section 447.205”). This section reads as follows: (a) When notice is required.”
Jennings Ex Rel. Jennings v. Alexander, 518 F. Supp. 877 (M.D. Tenn. 1981).
· cites it 5× “Finally, the plaintiffs contend that the injunction should remain in effect because of the state’s failure to publish notice of the proposed change as required by 42 C.F.R. § 447.205 . The court will address these contentions seriatim.”
California Ass'n of Bioanalysts v. Rank, 577 F. Supp. 1342 (C.D. Cal. 1983).
· cites it 3× “First, plaintiffs argue that the notice of the 25% *1348 reduction provided by DHS failed to satisfy the requirements of 42 C.F.R. § 447.205 (1982). Second, plaintiffs contend that DHS failed to give any notice of the amendment to the State Plan, which exempted legislatively…”
Oklahoma Nursing Home Ass'n v. Demps, 792 F. Supp. 721 (W.D. Okla. 1992).
· cites it 3× “The Defendants argue that neither the public notice regulation relied on in Count IV, 42 C.F.R. §§ 447.205 (c)(1) and (3), nor the Medical Care Advisory Committee regulation relied on in Count VI, 42 C.”
Am. Soc'y of Consultant Pharmacists v. Concannon, 214 F. Supp. 2d 23 (D. Me. 2002).
· cites it 2× “Finally, Plaintiff argues that when Defendant issued the emergency rule, it violated the notice requirements of 42 C.F.R. § 447.205 (c), a regulation implementing Section 30(A).”
Long Term Care Pharmacy All. v. Ferguson, 362 F.3d 50 (1st Cir. 2004).
“Although the statute does not provide any procedure for the determination of such “methods and procedures,” implementing regulations for the subsection require public notice of any “significant proposed change” in the “methods and standards for setting payment rates for…”
Arizona Hosp. & Healthcare Ass'n v. Betlach, 865 F. Supp. 2d 984 (D. Ariz. 2012).
· cites it 4× “§ 1396a(a)(30)(A) (“Section 30(A)”) and the Supremacy Clause; and (3) that public notice of the rate reductions was not properly given, in violation of 42 C.F.R. § 447.205 and the Supremacy Clause.”
Philadelphia Welfare Rights Org. v. O'Bannon, 517 F. Supp. 501 (E.D. Pa. 1981).
· cites it 3× “Notice Pursuant to 42 C.F.R. § 447.205 Before Changes in Method or Level of Reimbursement for a Service Are Made Plaintiffs argue next that the defendants failed to comply with the federal regulation, 42 C.”
— 42 C.F.R. § 447.205(a) — 1 case
— 42 C.F.R. § 447.205(c) — 2 cases
— 42 C.F.R. § 447.205(c)(1) — 2 cases
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