C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 447—PAYMENTS FOR SERVICES › Subpart F—Payment Methods for Other Institutional and Noninstitutional Services

42 C.F.R. § 447.321

Outpatient hospital and clinic services: Application of upper payment limits

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(a) Scope. This section applies to rates set by the agency to pay for outpatient services furnished by hospitals and clinics within one of the following categories:

(1) State government-owned or operated facilities (that is, all facilities that are owned or operated by the State.)

(2) Non-State government owned or operated facilities (that is, all government operated facilities that are neither owned nor operated by the State).

(3) Privately-owned and operated facilities.

(b) General rules. (1) Upper payment limit refers to a reasonable estimate of the amount that would be paid for the services furnished by the group of facilities under Medicare payment principles in subchapter B of this chapter.

(2) Except as provided in paragraph (c) of this section, aggregate Medicaid payments to a group of facilities within one of the categories described in paragraph (a) of this section may not exceed the upper payment limit described in paragraph (b)(1) of this section.

(c) Exceptions. Indian Health Services and tribal facilities. The limitation in paragraph (b) of this section does not apply to Indian Health Services facilities and tribal facilities that are funded through the Indian Self-Determination and Education Assistance Act (Pub. L. 93-638).

(d) Compliance dates. Except as permitted under paragraph (e) of this section, a State must comply with the upper payment limit described in paragraph (b)(1) of this section by one of the following dates:

(1) For non-State government-owned or operated hospitals—March 19, 2002.

(2) For all other facilities—March 13, 2001.

[66 FR 3176, Jan. 12, 2001, as amended at 66 FR 46399, Sept. 5, 2001; 67 FR 2611, Jan. 18, 2002; 72 FR 29835, May 29, 2007; 75 FR 73975, Nov. 30, 2010; 77 FR 31513, May 29, 2012]
Notes of Decisions
Cited in 7 cases, 1983–2016 · leading case: Arkansas Dep't of Human Servs. v. Sebelius, 818 F. Supp. 2d 107 (D.D.C. 2011).
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Arkansas Dep't of Human Servs. v. Sebelius, 818 F. Supp. 2d 107 (D.D.C. 2011). · cites it 13× “, 42 C.F.R. § 447.321 . As of October 2000, the outpatient hospital and clinic services regulation, 42 C.”
Carson City Hosp. v. Dep't of Cmty. Health, 656 N.W.2d 366 (Mich. Ct. App. 2003). “109(1)(b) in support of its argument in the trial court, but in the administrative hearing relied on 42 CFR 447.321(a), the legal issue is identical; therefore, it is preserved for our consideration.”
Ashley Cnty. Med. Ctr. v. Thompson, 205 F. Supp. 2d 1026 (E.D. Ark. 2002). “272 and 42 C.F.R. 447.321 — are known collectively as the 2002 Upper Payment Limit Rule.”
Michigan Hosp. Ass'n v. Dep't of Soc. Servs., 555 F. Supp. 675 (E.D. Mich. 1983). “She points out further that 42 CFR § 447.321 refers to outpatient Hospital Services and Clinic Services and relates to the upper limits of payments, and that this *678 section would be the one to which her agency would look in determining whether the method of payment proposed…”
New York v. Bowen, 811 F.2d 776 (2d Cir. 1987). “42 C.F.R. § 447.321 . Allowing the State to reimburse outpatient costs through section 1396a(a)(13)(A) would circumvent section 1396a(a)(30): Since the Amendment would include unreimbursed outpatient costs in setting inpatient rates, the ceiling on outpatient costs would be…”
Alaska Dep't of Health & Soc. Servs. v. Centers for Medicare & Medicaid Servs., 424 F.3d 931 (9th Cir. 2005). “272 ; 42 C.F.R. § 447.321 . However, “Indian Health Services facilities and tribal facilities” were specifically excepted from the scope of these new regulations.”
Commonwealth, Cabinet for Health & Fam. Servs. v. Owensboro Med. Health Sys., Inc., 500 S.W.3d 225 (Ky. Ct. App. 2016). “…Kentucky Administrative Regulations. 6. This is. reference- is to the Social Security Act, 42 U.S.C. Chapter 7. . See 42 C.F.R. § 447.321 (a).”
— 42 C.F.R. § 447.321(a) — 1 case
Carson City Hosp. v. Dep't of Cmty. Health, 656 N.W.2d 366 (Mich. Ct. App. 2003). “109(1)(b) in support of its argument in the trial court, but in the administrative hearing relied on 42 CFR 447.321(a), the legal issue is identical; therefore, it is preserved for our consideration.”
— 42 C.F.R. § 447.321(e) — 1 case
Arkansas Dep't of Human Servs. v. Sebelius, 818 F. Supp. 2d 107 (D.D.C. 2011). “, 42 C.F.R. § 447.321 . As of October 2000, the outpatient hospital and clinic services regulation, 42 C.”
— 42 C.F.R. § 447.321(e)(2)(ii)(C) — 1 case
Arkansas Dep't of Human Servs. v. Sebelius, 818 F. Supp. 2d 107 (D.D.C. 2011). “, 42 C.F.R. § 447.321 . As of October 2000, the outpatient hospital and clinic services regulation, 42 C.”
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