42 CFR 438.60
§ 438.60 Prohibition of additional payments for services covered under MCO, PIHP or PAHP contracts.
United States · 42 CFR — Public Health · Status: effective
Cite this
- Citation
- 42 CFR 438.60, § 438.60 Prohibition of additional payments for services covered under MCO, PIHP or PAHP contracts, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/206100
- Permanent ID
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Full text
The State agency must ensure that no payment is made to a network provider other than by the MCO, PIHP, or PAHP for services covered under the contract between the State and the MCO, PIHP, or PAHP, except when these payments are specifically required to be made by the State in Title XIX of the Act, in 42 CFR chapter IV, or when the State agency makes direct payments to network providers for graduate medical education costs approved under the State plan.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.