---
kind: "range"
citation: "42 C.F.R. §§ 447.302–447.325"
title: "42"
from: "447.302"
to: "447.325"
count: 4
url: "https://uscodex.org/cfr/42/447.302..447.325"
---

# §447.302. State plan requirements.


A State plan must provide that the requirements of this subpart are met.


# §447.304. Adherence to upper limits; FFP.

- (a) The Medicaid agency must not pay more than the upper limits described in this subpart.
- (b) In the case of payments made under the plan for deductibles and coinsurance payable on an assigned Medicare claim for noninstitutional services, those payments may be made only up to the reasonable charge under Medicare.
- (c) FFP is not available for a State's expenditures for services that are in excess of the amounts allowable under this subpart.

# §447.321. Outpatient hospital and clinic services: Application of upper payment limits.

- (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)](#c) of this section, aggregate Medicaid payments to a group of facilities within one of the categories described in [paragraph (a)](#a) of this section may not exceed the upper payment limit described in [paragraph (b)(1)](#b-1) of this section.
- (c) **Exceptions.** Indian Health Services and tribal facilities. The limitation in [paragraph (b)](#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)](#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.

# §447.325. Other inpatient and outpatient facility services: Upper limits of payment.


The agency may pay the customary charges of the provider but must not pay more than the prevailing charges in the locality for comparable services under comparable circumstances.