| 42:2.0.1.1.1 | PART 400
| PART 400 - INTRODUCTION; DEFINITIONS | |
| 42:2.0.1.1.1.1 | SUBPART A
| Subpart A [Reserved] | |
| 42:2.0.1.1.1.2 | SUBPART B
| Subpart B - Definitions | |
| 42:2.0.1.1.1.2.1.1 | SECTION 400.200
| 400.200 General definitions. | |
| 42:2.0.1.1.1.2.1.2 | SECTION 400.202
| 400.202 Definitions specific to Medicare. | |
| 42:2.0.1.1.1.2.1.3 | SECTION 400.203
| 400.203 Definitions specific to Medicaid. | |
| 42:2.0.1.1.1.3 | SUBPART C
| Subpart C [Reserved] | |
| 42:2.0.1.1.2 | PART 401
| PART 401 - GENERAL ADMINISTRATIVE REQUIREMENTS | |
| 42:2.0.1.1.2.1 | SUBPART A
| Subpart A [Reserved] | |
| 42:2.0.1.1.2.2 | SUBPART B
| Subpart B - Confidentiality and Disclosure | |
| 42:2.0.1.1.2.2.1.1 | SECTION 401.101
| 401.101 Purpose and scope. | |
| 42:2.0.1.1.2.2.1.2 | SECTION 401.102
| 401.102 Definitions. | |
| 42:2.0.1.1.2.2.1.3 | SECTION 401.105
| 401.105 Rules for disclosure. | |
| 42:2.0.1.1.2.2.1.4 | SECTION 401.106
| 401.106 Publication. | |
| 42:2.0.1.1.2.2.1.5 | SECTION 401.108
| 401.108 CMS rulings. | |
| 42:2.0.1.1.2.2.1.6 | SECTION 401.109
| 401.109 Precedential Final Decisions of the Secretary. | |
| 42:2.0.1.1.2.2.1.7 | SECTION 401.110
| 401.110 Publications for sale. | |
| 42:2.0.1.1.2.2.1.8 | SECTION 401.112
| 401.112 Availability of administrative staff manuals. | |
| 42:2.0.1.1.2.2.1.9 | SECTION 401.116
| 401.116 Availability of records upon request. | |
| 42:2.0.1.1.2.2.1.10 | SECTION 401.118
| 401.118 Deletion of identifying details. | |
| 42:2.0.1.1.2.2.1.11 | SECTION 401.120
| 401.120 Creation of records. | |
| 42:2.0.1.1.2.2.1.12 | SECTION 401.126
| 401.126 Information or records that are not available. | |
| 42:2.0.1.1.2.2.1.13 | SECTION 401.128
| 401.128 Where requests for records may be made. | |
| 42:2.0.1.1.2.2.1.14 | SECTION 401.130
| 401.130 Materials available at social security district offices and branch offices. | |
| 42:2.0.1.1.2.2.1.15 | SECTION 401.132
| 401.132 Materials in field offices of the Office of Hearings and Appeals, SSA. | |
| 42:2.0.1.1.2.2.1.16 | SECTION 401.133
| 401.133 Availability of official reports on providers and suppliers of services, State agencies, intermediaries, and carriers under Medicare. | |
| 42:2.0.1.1.2.2.1.17 | SECTION 401.134
| 401.134 Release of Medicare information to State and Federal agencies. | |
| 42:2.0.1.1.2.2.1.18 | SECTION 401.135
| 401.135 Release of Medicare information to the public. | |
| 42:2.0.1.1.2.2.1.19 | SECTION 401.136
| 401.136 Requests for information or records. | |
| 42:2.0.1.1.2.2.1.20 | SECTION 401.140
| 401.140 Fees and charges. | |
| 42:2.0.1.1.2.2.1.21 | SECTION 401.144
| 401.144 Denial of requests. | |
| 42:2.0.1.1.2.2.1.22 | SECTION 401.148
| 401.148 Administrative review. | |
| 42:2.0.1.1.2.2.1.23 | SECTION 401.152
| 401.152 Court review. | |
| 42:2.0.1.1.2.3 | SUBPART C
| Subpart C [Reserved] | |
| 42:2.0.1.1.2.4 | SUBPART D
| Subpart D - Reporting and Returning of Overpayments | |
| 42:2.0.1.1.2.4.1.1 | SECTION 401.301
| 401.301 Basis and scope. | |
| 42:2.0.1.1.2.4.1.2 | SECTION 401.303
| 401.303 Definitions. | |
| 42:2.0.1.1.2.4.1.3 | SECTION 401.305
| 401.305 Requirements for reporting and returning of overpayments. | |
| 42:2.0.1.1.2.5 | SUBPART E
| Subpart E [Reserved] | |
| 42:2.0.1.1.2.6 | SUBPART F
| Subpart F - Claims Collection and Compromise | |
| 42:2.0.1.1.2.6.1.1 | SECTION 401.601
| 401.601 Basis and scope. | |
| 42:2.0.1.1.2.6.1.2 | SECTION 401.603
| 401.603 Definitions. | |
| 42:2.0.1.1.2.6.1.3 | SECTION 401.605
| 401.605 Omissions not a defense. | |
| 42:2.0.1.1.2.6.1.4 | SECTION 401.607
| 401.607 Claims collection. | |
| 42:2.0.1.1.2.6.1.5 | SECTION 401.613
| 401.613 Compromise of claims. | |
| 42:2.0.1.1.2.6.1.6 | SECTION 401.615
| 401.615 Payment of compromise amount. | |
| 42:2.0.1.1.2.6.1.7 | SECTION 401.617
| 401.617 Suspension of collection action. | |
| 42:2.0.1.1.2.6.1.8 | SECTION 401.621
| 401.621 Termination of collection action. | |
| 42:2.0.1.1.2.6.1.9 | SECTION 401.623
| 401.623 Joint and several liability. | |
| 42:2.0.1.1.2.6.1.10 | SECTION 401.625
| 401.625 Effect of CMS claims collection decisions on appeals. | |
| 42:2.0.1.1.2.7 | SUBPART G
| Subpart G - Availability of Medicare Data for Performance Measurement | |
| 42:2.0.1.1.2.7.1.1 | SECTION 401.701
| 401.701 Purpose and scope. | |
| 42:2.0.1.1.2.7.1.2 | SECTION 401.703
| 401.703 Definitions. | |
| 42:2.0.1.1.2.7.1.3 | SECTION 401.705
| 401.705 Eligibility criteria for qualified entities. | |
| 42:2.0.1.1.2.7.1.4 | SECTION 401.707
| 401.707 Operating and governance requirements for qualified entities. | |
| 42:2.0.1.1.2.7.1.5 | SECTION 401.709
| 401.709 The application process and requirements. | |
| 42:2.0.1.1.2.7.1.6 | SECTION 401.711
| 401.711 Updates to plans submitted as part of the application process. | |
| 42:2.0.1.1.2.7.1.7 | SECTION 401.713
| 401.713 Ensuring the privacy and security of data. | |
| 42:2.0.1.1.2.7.1.8 | SECTION 401.715
| 401.715 Selection and use of performance measures. | |
| 42:2.0.1.1.2.7.1.9 | SECTION 401.716
| 401.716 Non-public analyses. | |
| 42:2.0.1.1.2.7.1.10 | SECTION 401.717
| 401.717 Provider and supplier requests for error correction. | |
| 42:2.0.1.1.2.7.1.11 | SECTION 401.718
| 401.718 Dissemination of data. | |
| 42:2.0.1.1.2.7.1.12 | SECTION 401.719
| 401.719 Monitoring and sanctioning of qualified entities. | |
| 42:2.0.1.1.2.7.1.13 | SECTION 401.721
| 401.721 Terminating an agreement with a qualified entity. | |
| 42:2.0.1.1.2.7.1.14 | SECTION 401.722
| 401.722 Qualified clinical data registries. | |
| 42:2.0.1.1.3 | PART 402
| PART 402 - CIVIL MONEY PENALTIES, ASSESSMENTS, AND EXCLUSIONS | |
| 42:2.0.1.1.3.1 | SUBPART A
| Subpart A - General Provisions | |
| 42:2.0.1.1.3.1.1.1 | SECTION 402.1
| 402.1 Basis and scope. | |
| 42:2.0.1.1.3.1.1.2 | SECTION 402.3
| 402.3 Definitions. | |
| 42:2.0.1.1.3.1.1.3 | SECTION 402.5
| 402.5 Right to a hearing before the final determination. | |
| 42:2.0.1.1.3.1.1.4 | SECTION 402.7
| 402.7 Notice of proposed determination. | |
| 42:2.0.1.1.3.1.1.5 | SECTION 402.9
| 402.9 Failure to request a hearing. | |
| 42:2.0.1.1.3.1.1.6 | SECTION 402.11
| 402.11 Notice to other agencies and other entities. | |
| 42:2.0.1.1.3.1.1.7 | SECTION 402.13
| 402.13 Penalty, assessment, and exclusion not exclusive. | |
| 42:2.0.1.1.3.1.1.8 | SECTION 402.15
| 402.15 Collateral estoppel. | |
| 42:2.0.1.1.3.1.1.9 | SECTION 402.17
| 402.17 Settlement. | |
| 42:2.0.1.1.3.1.1.10 | SECTION 402.19
| 402.19 Hearings and appeals. | |
| 42:2.0.1.1.3.1.1.11 | SECTION 402.21
| 402.21 Judicial review. | |
| 42:2.0.1.1.3.2 | SUBPART B
| Subpart B - Civil Money Penalties and Assessments | |
| 42:2.0.1.1.3.2.1.1 | SECTION 402.105
| 402.105 Amount of penalty. | |
| 42:2.0.1.1.3.2.1.2 | SECTION 402.107
| 402.107 Amount of assessment. | |
| 42:2.0.1.1.3.2.1.3 | SECTION 402.109
| 402.109 Statistical sampling. | |
| 42:2.0.1.1.3.2.1.4 | SECTION 402.111
| 402.111 Factors considered in determinations regarding the amount of penalties and assessments. | |
| 42:2.0.1.1.3.2.1.5 | SECTION 402.113
| 402.113 When a penalty and assessment are collectible. | |
| 42:2.0.1.1.3.2.1.6 | SECTION 402.115
| 402.115 Collection of penalty or assessment. | |
| 42:2.0.1.1.3.3 | SUBPART C
| Subpart C - Exclusions | |
| 42:2.0.1.1.3.3.1.1 | SECTION 402.200
| 402.200 Basis and purpose. | |
| 42:2.0.1.1.3.3.1.2 | SECTION 402.205
| 402.205 Length of exclusion. | |
| 42:2.0.1.1.3.3.1.3 | SECTION 402.208
| 402.208 Factors considered in determining whether to exclude, and the length of exclusion. | |
| 42:2.0.1.1.3.3.1.4 | SECTION 402.209
| 402.209 Scope and effect of exclusion. | |
| 42:2.0.1.1.3.3.1.5 | SECTION 402.210
| 402.210 Notices. | |
| 42:2.0.1.1.3.3.1.6 | SECTION 402.212
| 402.212 Response to notice of proposed determination to exclude. | |
| 42:2.0.1.1.3.3.1.7 | SECTION 402.214
| 402.214 Appeal of exclusion. | |
| 42:2.0.1.1.3.3.1.8 | SECTION 402.300
| 402.300 Request for reinstatement. | |
| 42:2.0.1.1.3.3.1.9 | SECTION 402.302
| 402.302 Basis for reinstatement. | |
| 42:2.0.1.1.3.3.1.10 | SECTION 402.304
| 402.304 Approval of request for reinstatement. | |
| 42:2.0.1.1.3.3.1.11 | SECTION 402.306
| 402.306 Denial of request for reinstatement. | |
| 42:2.0.1.1.3.3.1.12 | SECTION 402.308
| 402.308 Waivers of exclusions. | |
| 42:2.0.1.1.4 | PART 403
| PART 403 - SPECIAL PROGRAMS AND PROJECTS | |
| 42:2.0.1.1.4.1 | SUBPART A
| Subpart A [Reserved] | |
| 42:2.0.1.1.4.2 | SUBPART B
| Subpart B - Medicare Supplemental Policies | |
| 42:2.0.1.1.4.2.5 | SUBJGRP 5
| General Provisions | |
| 42:2.0.1.1.4.2.5.1 | SECTION 403.200
| 403.200 Basis and scope. | |
| 42:2.0.1.1.4.2.5.2 | SECTION 403.201
| 403.201 State regulation of insurance policies. | |
| 42:2.0.1.1.4.2.5.3 | SECTION 403.205
| 403.205 Medicare supplemental policy. | |
| 42:2.0.1.1.4.2.5.4 | SECTION 403.206
| 403.206 General standards for Medicare supplemental policies. | |
| 42:2.0.1.1.4.2.5.5 | SECTION 403.210
| 403.210 NAIC model standards. | |
| 42:2.0.1.1.4.2.5.6 | SECTION 403.215
| 403.215 Loss ratio standards. | |
| 42:2.0.1.1.4.2.6 | SUBJGRP 6
| State Regulatory Programs | |
| 42:2.0.1.1.4.2.6.7 | SECTION 403.220
| 403.220 Supplemental Health Insurance Panel. | |
| 42:2.0.1.1.4.2.6.8 | SECTION 403.222
| 403.222 State with an approved regulatory program. | |
| 42:2.0.1.1.4.2.7 | SUBJGRP 7
| Voluntary Certification Program: General Provisions | |
| 42:2.0.1.1.4.2.7.9 | SECTION 403.231
| 403.231 Emblem. | |
| 42:2.0.1.1.4.2.7.10 | SECTION 403.232
| 403.232 Requirements and procedures for obtaining certification. | |
| 42:2.0.1.1.4.2.7.11 | SECTION 403.235
| 403.235 Review and certification of policies. | |
| 42:2.0.1.1.4.2.7.12 | SECTION 403.239
| 403.239 Submittal of material to retain certification. | |
| 42:2.0.1.1.4.2.7.13 | SECTION 403.245
| 403.245 Loss of certification. | |
| 42:2.0.1.1.4.2.7.14 | SECTION 403.248
| 403.248 Administrative review of CMS determinations. | |
| 42:2.0.1.1.4.2.8 | SUBJGRP 8
| Voluntary Certification Program: Loss Ratio Provisions | |
| 42:2.0.1.1.4.2.8.15 | SECTION 403.250
| 403.250 Loss ratio calculations: General provisions. | |
| 42:2.0.1.1.4.2.8.16 | SECTION 403.251
| 403.251 Loss ratio date and time frame provisions. | |
| 42:2.0.1.1.4.2.8.17 | SECTION 403.253
| 403.253 Calculation of benefits. | |
| 42:2.0.1.1.4.2.8.18 | SECTION 403.254
| 403.254 Calculation of premiums. | |
| 42:2.0.1.1.4.2.8.19 | SECTION 403.256
| 403.256 Loss ratio supporting data. | |
| 42:2.0.1.1.4.2.8.20 | SECTION 403.258
| 403.258 Statement of actuarial opinion. | |
| 42:2.0.1.1.4.3 | SUBPART C
| Subpart C - Recognition of State Reimbursement Control Systems | |
| 42:2.0.1.1.4.3.9.1 | SECTION 403.300
| 403.300 Basis and purpose. | |
| 42:2.0.1.1.4.3.9.2 | SECTION 403.302
| 403.302 Definitions. | |
| 42:2.0.1.1.4.3.9.3 | SECTION 403.304
| 403.304 Minimum requirements for State systems - discretionary approval. | |
| 42:2.0.1.1.4.3.9.4 | SECTION 403.306
| 403.306 Additional requirements for State systems - mandatory approval. | |
| 42:2.0.1.1.4.3.9.5 | SECTION 403.308
| 403.308 State systems under demonstration projects - mandatory approval. | |
| 42:2.0.1.1.4.3.9.6 | SECTION 403.310
| 403.310 Reduction in payments. | |
| 42:2.0.1.1.4.3.9.7 | SECTION 403.312
| 403.312 Submittal of application. | |
| 42:2.0.1.1.4.3.9.8 | SECTION 403.314
| 403.314 Evaluation of State systems. | |
| 42:2.0.1.1.4.3.9.9 | SECTION 403.316
| 403.316 Reconsideration of certain denied applications. | |
| 42:2.0.1.1.4.3.9.10 | SECTION 403.318
| 403.318 Approval of State systems. | |
| 42:2.0.1.1.4.3.9.11 | SECTION 403.320
| 403.320 CMS review and monitoring of State systems. | |
| 42:2.0.1.1.4.3.9.12 | SECTION 403.321
| 403.321 State systems for hospital outpatient services. | |
| 42:2.0.1.1.4.3.9.13 | SECTION 403.322
| 403.322 Termination of agreements for Medicare recognition of State systems. | |
| 42:2.0.1.1.4.4 | SUBPART D
| Subparts D - F [Reserved] | |
| 42:2.0.1.1.4.5 | SUBPART G
| Subpart G - Religious Nonmedical Health Care Institutions - Benefits, Conditions of Participation, and Payment | |
| 42:2.0.1.1.4.5.9.1 | SECTION 403.700
| 403.700 Basis and purpose. | |
| 42:2.0.1.1.4.5.9.2 | SECTION 403.702
| 403.702 Definitions and terms. | |
| 42:2.0.1.1.4.5.9.3 | SECTION 403.720
| 403.720 Conditions for coverage. | |
| 42:2.0.1.1.4.5.9.4 | SECTION 403.724
| 403.724 Valid election requirements. | |
| 42:2.0.1.1.4.5.9.5 | SECTION 403.730
| 403.730 Condition of participation: Patient rights. | |
| 42:2.0.1.1.4.5.9.6 | SECTION 403.732
| 403.732 Condition of participation: Quality assessment and performance improvement. | |
| 42:2.0.1.1.4.5.9.7 | SECTION 403.734
| 403.734 Condition of participation: Food services. | |
| 42:2.0.1.1.4.5.9.8 | SECTION 403.736
| 403.736 Condition of participation: Discharge planning. | |
| 42:2.0.1.1.4.5.9.9 | SECTION 403.738
| 403.738 Condition of participation: Administration. | |
| 42:2.0.1.1.4.5.9.10 | SECTION 403.740
| 403.740 Condition of participation: Staffing. | |
| 42:2.0.1.1.4.5.9.11 | SECTION 403.742
| 403.742 Condition of participation: Physical environment. | |
| 42:2.0.1.1.4.5.9.12 | SECTION 403.744
| 403.744 Condition of participation: Life safety from fire. | |
| 42:2.0.1.1.4.5.9.13 | SECTION 403.745
| 403.745 Condition of participation: Building safety. | |
| 42:2.0.1.1.4.5.9.14 | SECTION 403.746
| 403.746 Condition of participation: Utilization review. | |
| 42:2.0.1.1.4.5.9.15 | SECTION 403.748
| 403.748 Condition of participation: Emergency preparedness. | |
| 42:2.0.1.1.4.5.9.16 | SECTION 403.750
| 403.750 Estimate of expenditures and adjustments. | |
| 42:2.0.1.1.4.5.9.17 | SECTION 403.752
| 403.752 Payment provisions. | |
| 42:2.0.1.1.4.5.9.18 | SECTION 403.754
| 403.754 Monitoring expenditure level. | |
| 42:2.0.1.1.4.5.9.19 | SECTION 403.756
| 403.756 Sunset provision. | |
| 42:2.0.1.1.4.5.9.20 | SECTION 403.764
| 403.764 Basis and purpose of religious nonmedical health care institutions providing home service. | |
| 42:2.0.1.1.4.5.9.21 | SECTION 403.766
| 403.766 Requirements for coverage and payment of RNHCI home services. | |
| 42:2.0.1.1.4.5.9.22 | SECTION 403.768
| 403.768 Excluded services. | |
| 42:2.0.1.1.4.5.9.23 | SECTION 403.770
| 403.770 Payments for home services. | |
| 42:2.0.1.1.4.6 | SUBPART H
| Subpart H - Medicare Prescription Drug Discount Card and Transitional Assistance Program | |
| 42:2.0.1.1.4.6.9.1 | SECTION 403.800
| 403.800 Basis and scope. | |
| 42:2.0.1.1.4.6.9.2 | SECTION 403.802
| 403.802 Definitions. | |
| 42:2.0.1.1.4.6.9.3 | SECTION 403.804
| 403.804 General rules for solicitation, application and Medicare endorsement period. | |
| 42:2.0.1.1.4.6.9.4 | SECTION 403.806
| 403.806 Sponsor requirements for eligibility for endorsement. | |
| 42:2.0.1.1.4.6.9.5 | SECTION 403.808
| 403.808 Use of transitional assistance funds. | |
| 42:2.0.1.1.4.6.9.6 | SECTION 403.810
| 403.810 Eligibility and reconsiderations. | |
| 42:2.0.1.1.4.6.9.7 | SECTION 403.811
| 403.811 Enrollment and disenrollment and associated endorsed sponsor requirements. | |
| 42:2.0.1.1.4.6.9.8 | SECTION 403.812
| 403.812 HIPAA privacy, security, administrative data standards, and national identifiers. | |
| 42:2.0.1.1.4.6.9.9 | SECTION 403.813
| 403.813 Marketing limitations and record retention requirements. | |
| 42:2.0.1.1.4.6.9.10 | SECTION 403.814
| 403.814 Special rules concerning Part C organizations and Medicare cost plans and their enrollees. | |
| 42:2.0.1.1.4.6.9.11 | SECTION 403.815
| 403.815 Special rules concerning States. | |
| 42:2.0.1.1.4.6.9.12 | SECTION 403.816
| 403.816 Special rules concerning long-term care and I/T/U pharmacies. | |
| 42:2.0.1.1.4.6.9.13 | SECTION 403.817
| 403.817 Special rules concerning the territories. | |
| 42:2.0.1.1.4.6.9.14 | SECTION 403.820
| 403.820 Sanctions, penalties, and termination. | |
| 42:2.0.1.1.4.6.9.15 | SECTION 403.822
| 403.822 Reimbursement of transitional assistance and associated sponsor requirements. | |
| 42:2.0.1.1.4.7 | SUBPART I
| Subpart I - Transparency Reports and Reporting of Physician Ownership or Investment Interests | |
| 42:2.0.1.1.4.7.9.1 | SECTION 403.900
| 403.900 Purpose and scope. | |
| 42:2.0.1.1.4.7.9.2 | SECTION 403.902
| 403.902 Definitions. | |
| 42:2.0.1.1.4.7.9.3 | SECTION 403.904
| 403.904 Reports of payments or other transfers of value to covered recipients. | |
| 42:2.0.1.1.4.7.9.4 | SECTION 403.906
| 403.906 Reports of physician ownership and investment interests. | |
| 42:2.0.1.1.4.7.9.5 | SECTION 403.908
| 403.908 Procedures for electronic submission of reports. | |
| 42:2.0.1.1.4.7.9.6 | SECTION 403.910
| 403.910 Delayed publication for payments made under product research or development agreements and clinical investigations. | |
| 42:2.0.1.1.4.7.9.7 | SECTION 403.912
| 403.912 Penalties for failure to report. | |
| 42:2.0.1.1.4.7.9.8 | SECTION 403.914
| 403.914 Preemption of State laws. | |
| 42:2.0.1.1.4.8 | SUBPART K
| Subpart K - Access to Identifiable Data for the Center for Medicare and Medicaid Models | |
| 42:2.0.1.1.4.8.9.1 | SECTION 403.1100
| 403.1100 Purpose and scope. | |
| 42:2.0.1.1.4.8.9.2 | SECTION 403.1105
| 403.1105 Definitions. | |
| 42:2.0.1.1.4.8.9.3 | SECTION 403.1110
| 403.1110 Evaluation of models. | |
| 42:2.0.1.1.4.9 | SUBPART L
| Subpart L - Requirements for Direct-to-Consumer Television Advertisements of Drugs and Biological Products To Include the List Price of That Advertised Product | |
| 42:2.0.1.1.4.9.9.1 | SECTION 403.1200
| 403.1200 Scope. | |
| 42:2.0.1.1.4.9.9.2 | SECTION 403.1201
| 403.1201 Definitions. | |
| 42:2.0.1.1.4.9.9.3 | SECTION 403.1202
| 403.1202 Pricing information. | |
| 42:2.0.1.1.4.9.9.4 | SECTION 403.1203
| 403.1203 Specific presentation requirements. | |
| 42:2.0.1.1.4.9.9.5 | SECTION 403.1204
| 403.1204 Compliance. | |
| 42:2.0.1.1.5 | PART 404
| Part 404 - XXX | |