42 C.F.R. § 447.252
State plan requirements
(a) The plan must provide that the requirements of this subpart are met.
(b) The plan must specify comprehensively the methods and standards used by the agency to set payment rates in a manner consistent with § 430.10 of this chapter.
(c) If the agency chooses to apply the cost limits established under Medicare (see § 413.30 of this chapter) on an individual provider basis, the plan must specify this requirement.
Notes of Decisions
Cited in 44
cases (2 in the last 5 years), 1982–2025 · leading case: Child.'s Hosp. & Health Ctr., a Washington Corp. v. S. Kimberly Belshe, Dir., California Dep't of Health Servs., 188 F.3d 1090 (9th Cir. 1999).
Child.'s Hosp. & Health Ctr., a Washington Corp. v. S. Kimberly Belshe, Dir., California Dep't of Health Servs., 188 F.3d 1090 (9th Cir. 1999). “298 ; (2) to make findings that their rates were reasonable and adequate, 42 C.F.R. § 447.252 (b); and (3) to assure reasonable access to inpatient hospital care, 42 C.”
Thomas v. Johnston, 557 F. Supp. 879 (W.D. Tex. 1983). “Among the arguments Plaintiffs make with respect to this claim is that Defendants violated the statute and 42 C.F.R. § 447.252 (b) 5 by failing to make a proper finding, after consideration of all relevant factors, that the rates are in fact reasonable and adequate to meet the…”
Mississippi Hosp. Ass'n v. Heckler, 701 F.2d 511 (5th Cir. 1983). “Under current federal regulations, state Medicaid agencies are required to make assurances to the Secretary that: (1) the requirement in 42 C.F.R. § 447.252 (a)(1) that the state agency must use “rates that are reasonable and adequate to meet the costs that must be incurred by…”
Coalition of Michigan Nursing Homes, Inc. v. Dempsey, 537 F. Supp. 451 (E.D. Mich. 1982). “The new regulations, mostly a restatement of the statutory language, required the states to find that payment rates to LTCFs are “reasonable and adequate” and so assure HHS, 42 C.F.R. § 447.252 , ensure that the state plan conforms to the new standards, § 447.”
California Hosp. Ass'n v. Schweiker, 559 F. Supp. 110 (C.D. Cal. 1982). “42 C.F.R. § 447.252 (c). Instead, State DHS submitted its findings to HCFA in the form of the background support document and the assurances letter, which referred to the data and comparisons in the background support document.”
The Commonwealth of Massachusetts, by Its Dep't of Pub. Welfare v. Sec'y of Health & Human Servs., 749 F.2d 89 (1st Cir. 1984). “” See 42 C.F.R. § 447.252 (a), (c), .315(a), .316(a) (1979).”
Mary Washington Hosp., Inc. v. Fisher, 635 F. Supp. 891 (E.D. Va. 1985). “42 C.F.R. § 447.252 (a)(b) and (c). The regulations also require each state to provide an appeals procedure that allows individual hospitals an opportunity to submit additional evidence and request prompt administrative review of payment rates.”
Santa Rosa Mem'l Hosp., Inc. v. Kent, 236 Cal. Rptr. 3d 199 (Cal. Ct. App. 5th 2018). “" ( 42 C.F.R. § 447.252 (b).) "When originally enacted in 1965, the Medicaid Act required states to reimburse health care providers for the 'reasonable cost' of hospital services rendered; the term 'reasonable cost' was defined under federal standards to correspond to the cost…”
Caritas Servs., Inc. v. Dep't of Soc. & Health Servs., 869 P.2d 28 (Wash. 1994). “42 C.F.R. § 447.252 (b). The state plan for 1989-1990, approved by HCFA, incorporates by reference the provisions of RCW 74.”
Child.'s Mem'l Hosp. v. Illinois Dep't of Pub. Aid, 562 F. Supp. 165 (N.D. Ill. 1983). “Reasonable Likelihood of Success on the Merits This Court recognizes the merits of Children’s -Memorial's claims must be viewed in the context of approval (contemporaneously with the filing of this lawsuit) of IDPA’s reimbursement formula by the Health Care Financing…”
California Hosp. Assn. v. Maxwell-jolly, 188 Cal. App. 4th 559 (Cal. Ct. App. 2010). “( 42 C.F.R. § 447.252 (b) (2009); Mission Hospital, supra, 168 Cal.”
42 soc.sec.rep.ser. 193, Medicare&medicaid Gu 41,767 Abbeville Gen. Hosp. v. David L. Ramsey, Sec'y, Dep't of Health & Hospitals, 3 F.3d 797 (5th Cir. 1993). “Part and parcel of this requirement is that a state find that lower rates are imposed on hospitals providing inappropriate levels of care as mandated in 42 C.F.R. § 447.252 (a)(3)(ii). Mississippi Hasp.”
— 42 C.F.R. § 447.252(a) — 1 case
Indiana State Dep't of Pub. Welfare v. Lifelines of Indianapolis Ltd. P'ship, 637 N.E.2d 1349 (Ind. Ct. App. 1994).
— 42 C.F.R. § 447.252(b) — 2 cases
Child.'s Hosp. & Health Ctr., a Washington Corp. v. S. Kimberly Belshe, Dir., California Dep't of Health Servs., 188 F.3d 1090 (9th Cir. 1999). “298 ; (2) to make findings that their rates were reasonable and adequate, 42 C.F.R. § 447.252 (b); and (3) to assure reasonable access to inpatient hospital care, 42 C.”
California Med. Ass'n v. Douglas, 848 F. Supp. 2d 1117 (C.D. Cal. 2012).
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