# 42 CFR § 447.20: Provider restrictions: State plan requirements

> Federal · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/ecfr-42-447.20

## Section

- **Citation:** 42 CFR § 447.20
- **Heading:** Provider restrictions: State plan requirements
- **Jurisdiction:** Federal
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** September 22, 2026
- **Source:** Publisher's official text
- **Location:** Title 42—Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS > PART 447—PAYMENTS FOR SERVICES > Subpart A—Payments: General Provisions

## Text

A State plan must provide for the following:
(a) In the case of an individual who is eligible for medical assistance under the plan for service(s) for which a third party or parties is liable for payment, if the total amount of the established liability of the third party or parties for the service is—
(1) Equal to or greater than the amount payable under the State plan (which includes, when applicable, cost-sharing payments provided for in §§ 447.52 through 447.54), the provider furnishing the service to the individual may not seek to collect from the individual (or any financially responsible relative or representative of that individual) any payment amount for that service; or
(2) Less than the amount payable under the State plan (including cost sharing payments set forth in §§ 447.52 through 447.54), the provider furnishing the service to that individual may collect from the individual (or any financially responsible relative or representative of the individual) an amount which is the lesser of—
(i) Any cost-sharing payment amount imposed upon the individual under §§ 447.52 through 447.54; or
(ii) An amount which represents the difference between the amount payable under the State plan (which includes, where applicable, cost-sharing payments provided for in §§ 447.52 through 447.54) and the total of the established third party liability for the services.
(b) A provider may not refuse to furnish services covered under the plan to an individual who is eligible for medical assistance under the plan on account of a third party's potential liability for the service(s).
[55 FR 1433, Jan. 16, 1990, as amended at 78 FR 42307, July 15, 2013]

## Nearby sections

- [42 CFR § 447.1 § 447.1 Purpose.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.1.md)
- [42 CFR § 447.10 § 447.10 Prohibition against reassignment of provider claims.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.10.md)
- [42 CFR § 447.15 § 447.15 Acceptance of State payment as payment in full.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.15.md)
- [42 CFR § 447.20 § 447.20 Provider restrictions: State plan requirements.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.20.md)
- [42 CFR § 447.21 § 447.21 Reduction of payments to providers.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.21.md)
- [42 CFR § 447.25 § 447.25 Direct payments to certain beneficiaries for physicians' or dentists' services.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.25.md)
- [42 CFR § 447.26 § 447.26 Prohibition on payment for provider-preventable conditions.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.26.md)
- [42 CFR § 447.30 § 447.30 Withholding the Federal share of payments to Medicaid providers to recover Medicare overpayments.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.30.md)
- [42 CFR § 447.31 § 447.31 Withholding Medicare payments to recover Medicaid overpayments.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.31.md)
- [42 CFR § 447.40 § 447.40 Payments for reserving beds in institutions.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.40.md)
- [42 CFR § 447.45 § 447.45 Timely claims payment.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.45.md)
- [42 CFR § 447.46 § 447.46 Timely claims payment by MCOs.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.46.md)
- [42 CFR § 447.200 § 447.200 Basis and purpose.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.200.md)
- [42 CFR § 447.201 § 447.201 State plan requirements.](https://www.frixlaw.com/law-library/statutes/ecfr-42-447.201.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/ecfr-42-447.20. Check the current official text before relying on it. Not legal advice.