Fed Regist. 2007 May 29;72(102):29747-836.
This regulation clarifies that entities involved in the financing of the non-Federal share of Medicaid payments must be a unit of government; clarifies the documentation required to support a Medicaid certified public expenditure; limits Medicaid reimbursement for health care providers that are operated by units of government to an amount that does not exceed the health care provider's cost of providing services to Medicaid individuals; requires all health care providers to receive and retain the full amount of total computable payments for services furnished under the approved Medicaid State plan; and makes conforming changes to provisions governing the State Child Health Insurance Program (SCHIP) to make the same requirements applicable, with the exception of the cost limit on reimbursement. The Medicaid cost limit provision of this regulation does not apply to: Stand-alone SCHIP program payments made to governmentally-operated health care providers; Indian Health Service (IHS) facilities and tribal 638 facilities that are paid at the all-inclusive IHS rate; Medicaid Managed Care Organizations (MCOs), Prepaid Inpatient Health Plans (PIHPs), and Prepaid Ambulatory Health Plans (PAHPs); Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Moreover, disproportionate share hospital (DSH) payments and payments authorized under Section 701(d) and Section 705 of the Benefits Improvement Protection Act of 2000 are not subject to the newly established Medicaid cost limit for governmentally-operated health care providers. Except as noted above, all Medicaid payments and SCHIP payments made under the authority of the State plan and under waiver and demonstration authorities, as well as associated State Medicaid and SCHIP financing arrangements, are subject to all provisions of this regulation. Finally, this regulation solicits comments from the public on issues related to the definition of the Unit of Government.
本法规明确规定，参与为医疗补助计划（Medicaid）非联邦份额付款提供资金的实体必须是政府单位；明确了支持医疗补助计划认证公共支出所需的文件；将政府单位运营的医疗服务提供者的医疗补助计划报销限制在不超过该医疗服务提供者向医疗补助计划参保人提供服务成本的金额；要求所有医疗服务提供者收取并保留根据已批准的医疗补助计划州计划提供服务的全部可计算付款总额；并对州儿童健康保险计划（SCHIP）的相关规定进行相应修改，以使相同要求适用，但报销成本限制除外。本法规的医疗补助计划成本限制条款不适用于：向政府运营的医疗服务提供者支付的独立州儿童健康保险计划款项；按照印第安卫生服务局（IHS）全包费率支付的印第安卫生服务设施和部落638设施；医疗补助计划管理式医疗组织（MCOs）、预付住院健康计划（PIHPs）和预付门诊健康计划（PAHPs）；联邦合格健康中心（FQHCs）和农村健康诊所（RHCs）。此外，不成比例份额医院（DSH）付款以及根据《2000年福利改善保护法》第701(d)条和第705条授权的付款不受新设立的政府运营医疗服务提供者医疗补助计划成本限制的约束。除上述情况外，根据州计划以及豁免和示范授权进行的所有医疗补助计划付款和州儿童健康保险计划付款，以及相关的州医疗补助计划和州儿童健康保险计划融资安排，均受本法规所有条款的约束。最后，本法规就与政府单位定义相关的问题征求公众意见。
