42 CFR 447.512 - Drugs: Aggregate upper limits of payment.

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There is 1 rule appearing in the Federal Register for 42 CFR 447. View below or at eCFR (GPOAccess)
§ 447.512 Drugs: Aggregate upper limits of payment.
(a) [Reserved]
(b) Other drugs. The agency payments for brand name drugs certified in accordance with paragraph (c) of this section and drugs other than multiple source drugs for which a specific limit has been established must not exceed, in the aggregate, payments levels that the agency has determined by applying the lower of the—.
(1) EAC plus reasonable dispensing fees established by the agency; or
(2) Providers' usual and customary charges to the general public.
(c) Certification of brand name drugs.
(1) The upper limit for payment for multiple source drugs for which a specific limit has been established does not apply if a physician certifies in his or her own handwriting (or by an electronic alternative means approved by the Secretary) that a specific brand is medically necessary for a particular beneficiary.
(2) The agency must decide what certification form and procedure are used.
(3) A check-off box on a form is not acceptable but a notation like “brand necessary” is allowable.
(4) The agency may allow providers to keep the certification forms if the forms will be available for inspection by the agency or HHS.
[72 FR 39239, July 17, 2007, as amended at 75 FR 69597, Nov. 15, 2010]

Title 42 published on 2014-10-01

The following are only the Rules published in the Federal Register after the published date of Title 42.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2014-12-03; vol. 79 # 232 - Wednesday, December 3, 2014
    1. 79 FR 71679 - Medicaid Program; Disproportionate Share Hospital Payments—Uninsured Definition
      GPO FDSys XML | Text
      DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services
      Final rule.
      Effective December 31, 2014.
      42 CFR Part 447

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United States Code

Title 42 published on 2014-10-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 42 CFR 447 after this date.

  • 2014-12-03; vol. 79 # 232 - Wednesday, December 3, 2014
    1. 79 FR 71679 - Medicaid Program; Disproportionate Share Hospital Payments—Uninsured Definition
      GPO FDSys XML | Text
      DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services
      Final rule.
      Effective December 31, 2014.
      42 CFR Part 447