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Medicaid Public Provider Cost Limit Rule and Summary

In the final rule from the Centers for Medicare & Medicaid Services (CMS), the agency clarifies:

  • entities involved in financing of the non-federal share of Medicaid payments must be a governmental entity
  • the documentation required to support a Medicaid certified public expenditure
  • Medicaid reimbursement for health care providers operated by a governmental entity is limited to an amount that does not exceed the health care provider’s cost of providing services to Medicaid individuals
  • all health care providers are required to receive and retain the full amount of total computable payments for services furnished under the approved Medicaid state plan
  • conforming changes to provisions governing the State Child Health Insurance Program to make the same requirements applicable

Final Rule

Published May 2007.

Association Summary of Final Rule

Prepared May 2007.

 

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