42 C.F.R. § 447.255
Related information
The Medicaid agency must submit, with the assurances described in § 447.253(a), the following information:
(a) The amount of the estimated average proposed payment rate for each type of provider (hospital, ICF/IID, or nursing facility), and the amount by which that estimated average rate increased or decreased relative to the average payment rate in effect for each type or provider for the immediately preceding rate period;
(b) An estimate of the short-term and, to the extent feasible, long-term effect the change in the estimated average rate will have on—
(1) The availability of services on a Statewide and geographic area basis;
(2) The type of care furnished;
(3) The extent of provider participation; and
(4) The degree to which costs are covered in hospitals that serve a disproportionate number of low income patients with special needs.
Notes of Decisions
Cited in 14
cases, 1982–1994 · leading case: Wilder v. Virginia Hosp. Assn., 496 U.S. 498 (1990).
Wilder v. Virginia Hosp. Assn., 496 U.S. 498 (1990). “42 CFR § 447.255 (1989). The Secretary may, however, request a State to provide additional background information if he believes it is necessary for a complete review of the State's assurances.”
Coalition of Michigan Nursing Homes, Inc. v. Dempsey, 537 F. Supp. 451 (E.D. Mich. 1982). “The amendment to the state plan which would implement the reduction was forwarded to HHS with the requested assurances and related information, 42 C.F.R. 447.255, on December 4, 1981 for the Secretary’s approval, which DSS received December 23, 1981.”
Alabama Hosp. Ass'n, a Corp. v. Rebecca Beasley, Individually, & in Her Capacity as Comm'r of the Alabama Medicaid Agency, 702 F.2d 955 (11th Cir. 1983). “On appeal plaintiffs argue that viewed in light of the new code provision HHS’s approval of the plan cannot stand because (1) HHS failed to promulgate standards defining the efficient cost standard; (2) the state did not submit to HHS the information required by 42 C.F.R. §…”
New England Mem'l Hosp. v. Rate Setting Comm'n, 475 N.E.2d 740 (Mass. 1985). “” 42 C.F.R. § 447.255 (a) (1981). The agency must assure in part that (1) rates are reasonable and adequate to meet the costs of an efficient and economically operated provider, (2) rates are adequate to assure recipients access to inpatient hospital services of adequate…”
Thomas v. Johnston, 557 F. Supp. 879 (W.D. Tex. 1983). “” Should Defendants wish to take the position that providers have no right to and should not specialize in high-cost cases, then Defendants should make that fact known to HCFA and inform HCFA of the implications of that position, see 42 C.F.R. § 447.255 (b)(2), so that HCFA may…”
Wisconsin Hosp. Ass'n v. Reivitz, 733 F.2d 1226 (7th Cir. 1984). “42 C.F.R. § 447.255 (a). In addition to the assurances, the agency must submit detailed information concerning the impact of any changes on different types of services.”
Child.'s Hosp. v. Sec'y of Dep't of Pub. Welfare, 568 F. Supp. 1001 (E.D. Pa. 1983). “The regulations require that when a state Medicaid agency wishes to make a significant change in its methods and standards for determining reimbursement rates, it must submit certain enumerated findings, assurances, and related information to the Secretary of HHS (“the…”
Bethany Med. Ctr. v. Harder, 641 F. Supp. 214 (D. Kan. 1986). “42 C.F.R. § 447.255 (b)(4). II. Facts. The facts relevant to resolution of this motion are as follows.”
Kansas Health Care Ass'n v. Kansas Dep't of Soc. & Rehab. Servs., 754 F. Supp. 1502 (D. Kan. 1990). “Thus, plaintiffs have raised serious questions on the issue of whether the state’s findings support the assurances procedurally required under federal law, specifically 42 C.F.R. § 447.255 (b). Although Secretary Taylor testified that it is not unusual for a preliminary budget…”
Nebraska Health Care Ass'n v. Dunning, 778 F.2d 1291 (8th Cir. 1985). “42 C.F.R. § 447.255 (b) (1982). As the District Court observed, The defendants admit that the department did not conduct any objective analysis or studies to determine the effects of § 68-720’s limitation on the level of care Medicaid patients would receive or the extent to…”
Bethany Med. Ctr. v. Harder, 693 F. Supp. 968 (D. Kan. 1988). “42 C.F.R. § 447.255 . In this process, HCFA’s only authority is to ensure that the states submitting plan amendments comply with the regulations by providing the required assurances; the agency had no obligation to independently evaluate the accuracy of the state's determination…”
Erie Cnty. Geriatric Ctr. v. Sullivan, 952 F.2d 71 (3rd Cir. 1991). “42 C.F.R. § 447.255 (a) (1982). 4 The regulations thus did not require the State to submit its findings, but only to accompany its assurances with “related information.”
— 42 C.F.R. § 447.255(a) — 1 case
Coalition of Michigan Nursing Homes, Inc. v. Dempsey, 537 F. Supp. 451 (E.D. Mich. 1982). “The amendment to the state plan which would implement the reduction was forwarded to HHS with the requested assurances and related information, 42 C.F.R. 447.255, on December 4, 1981 for the Secretary’s approval, which DSS received December 23, 1981.”
— 42 C.F.R. § 447.255(b)(2) — 1 case
Coalition of Michigan Nursing Homes, Inc. v. Dempsey, 537 F. Supp. 451 (E.D. Mich. 1982). “The amendment to the state plan which would implement the reduction was forwarded to HHS with the requested assurances and related information, 42 C.F.R. 447.255, on December 4, 1981 for the Secretary’s approval, which DSS received December 23, 1981.”
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