(a) This subpart implements section 1902(a)(13)(A) of the Act, which requires that the State plan provide for payment for hospital and long-term care facility services through the use of rates that the State finds, and makes assurances satisfactory to the Secretary, are reasonable and adequate to meet the costs that must be incurred by efficiently and economically operated facilities to provide services in conformity with State and Federal laws, regulations, and quality and safety standards.
(b) Section 447.253(a)(2) implements section 1902(a)(30) of the Act, which requires that payments be consistent with efficiency, economy, and quality of care;
(c) Sections 447.253 (c) and (d) implement sections 1902(a)(13)(B) and 1902(a)(13)(C) of the Act, which require a State Medicaid agency to make certain assurances to the Secretary regarding increases in payments resulting solely from changes in ownerships of hospitals, NFs, and ICFs/IID.
(d) Section 447.271 implements section 1903(i)(3) of the Act, which requires that payments for inpatient hospital services not exceed the hospital's customary charges.
(e) Section 447.280 implements section 1913(b) of the Act, which concerns reimbursement for long-term care services furnished by swing-bed hospitals.
[48 FR 56057, Dec. 19, 1983, as amended at 57 FR 43921, Sept. 23, 1992]
Notes of Decisions
Olszewski v. Scripps Health, 69 P.3d 927 (Cal. 2003).
· cites it 2× “" ( 42 C.F.R. § 447.250 (a).) To receive reimbursement from a state Medicaid plan, a health care provider must enter into a provider agreement with the state Medicaid agency.”
Thomas v. Johnston, 557 F. Supp. 879 (W.D. Tex. 1983).
“See 42 C.F.R. §§ 447.250 to .272. The above-described change in the federal reimbursement standard in no way altered federal substantive standards relating to the amount and quality of care that ICF-MR facilities must provide.”
Mary Washington Hosp., Inc. v. Fisher, 635 F. Supp. 891 (E.D. Va. 1985).
“See 42 C.F.R. § 447.250 et seq. (1981). The regulations provide in pertinent part that (a) inpatient hospital service payment rates must be reasonable and adequate to meet the “economy and efficiency” and “reasonable access” standards described supra; (b) that the states must…”
Michigan Hosp. Ass'n v. Dep't of Soc. Servs., 555 F. Supp. 675 (E.D. Mich. 1983).
· cites it 3× “§ 1396a(a)(13)(A) (1981) 2 and implementing regulations, 42 CFR § 447.250 et. seq. Plaintiff relies on the fact that Michigan has failed to make the findings and assurances required by the statute.”
Coalition of Michigan Nursing Homes, Inc. v. Dempsey, 537 F. Supp. 451 (E.D. Mich. 1982).
“These regulations implement both the new “reasonable and adequate” standards of The Boren Amendment to OBRA of 1980 and the extension of those standards to hospitals and a 3% reduction in federal funding under OBRA of 1981. While HHS may have initially had nine months (from…”
DeGregorio v. O'BANNON, 500 F. Supp. 541 (E.D. Pa. 1980).
“See 42 C.F.R. § 447.250 . 9 . This limitation applies to proprietary facilities.”
Oklahoma Nursing Home Ass'n v. Demps, 792 F. Supp. 721 (W.D. Okla. 1992).
“§ 1396a(a)(13) and 42 C.F.R. § 447.250 , et seq. 4 . Defendants initially argued that “[u]nder the Boren Amendment, the only issue is whether the actual rate — the "bottom line” — is reasonable and adequate_" Memorandum In Support of Defendants’ Motion to Dismiss, p.”
HCMF Corp. v. Gilmore, 26 F. Supp. 2d 873 (W.D. Va. 1998).
“First, as the court has already held, recovery in federal court for past applications of the now repealed Boren Amendment is precluded by the Eleventh Amendment because it is a thinly veiled attempt to obtain damages from the state. Second, nothing in the Medicaid Act and…”
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