CMS-179 4.19(f)

Medicaid State Plan Base Plan Pages (CMS-179)

Exhibit AC 508 (rev OSORA PRA)

OMB: 0938-0193

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Form Approved CMS-179
OMB No. 0938-0193
62
Revision:

HCFA-PM-87-4
MARCH 1987

(BERC)

OMB No.: 0938-0193

State/Territory:
Citation
42 CFR 447.15
1916A (d)(2)

4.19(f) The Medicaid agency limits participation to
providers who meet the requirements of
42 CFR 447.15.
No provider participating under this plan may deny
services to any individual eligible under the plan on
account of the individual's inability to pay a cost
sharing amount imposed by the plan in accordance with
42 CFR 447.53. This service guarantee does not apply to
an individual who is able to pay, nor does an
individual's inability to pay eliminate his or her liability
for the cost sharing change.

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TN No.
Supersedes
Approval Date
Effective Date
TN No.
HCFA ID: 101OP/0012P
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