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Title 42 Part 403

Title 42 → Chapter IV → Subchapter A → Part 403

Electronic Code of Federal Regulations e-CFR

Title 42 Part 403

Title 42Chapter IVSubchapter APart 403


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER A—GENERAL PROVISIONS

PART 403—SPECIAL PROGRAMS AND PROJECTS

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Subpart A—[RESERVED]

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Subpart B—MEDICARE SUPPLEMENTAL POLICIES

§403.200
Basis and scope.

General Provisions

§403.201
State regulation of insurance policies.
§403.205
Medicare supplemental policy.
§403.206
General standards for Medicare supplemental policies.
§403.210
NAIC model standards.
§403.215
Loss ratio standards.

State Regulatory Programs

§403.220
Supplemental Health Insurance Panel.
§403.222
State with an approved regulatory program.

Voluntary Certification Program: General Provisions

§403.231
Emblem.
§403.232
Requirements and procedures for obtaining certification.
§403.235
Review and certification of policies.
§403.239
Submittal of material to retain certification.
§403.245
Loss of certification.
§403.248
Administrative review of CMS determinations.

Voluntary Certification Program: Loss Ratio Provisions

§403.250
Loss ratio calculations: General provisions.
§403.251
Loss ratio date and time frame provisions.
§403.253
Calculation of benefits.
§403.254
Calculation of premiums.
§403.256
Loss ratio supporting data.
§403.258
Statement of actuarial opinion.
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Subpart C—RECOGNITION OF STATE REIMBURSEMENT CONTROL SYSTEMS

§403.300
Basis and purpose.
§403.302
Definitions.
§403.304
Minimum requirements for State systems—discretionary approval.
§403.306
Additional requirements for State systems—mandatory approval.
§403.308
State systems under demonstration projects—mandatory approval.
§403.310
Reduction in payments.
§403.312
Submittal of application.
§403.314
Evaluation of State systems.
§403.316
Reconsideration of certain denied applications.
§403.318
Approval of State systems.
§403.320
CMS review and monitoring of State systems.
§403.321
State systems for hospital outpatient services.
§403.322
Termination of agreements for Medicare recognition of State systems.
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Subparts D—F [Reserved]

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Subpart G—RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS—BENEFITS, CONDITIONS OF PARTICIPATION, AND PAYMENT

§403.700
Basis and purpose.
§403.702
Definitions and terms.
§403.720
Conditions for coverage.
§403.724
Valid election requirements.
§403.730
Condition of participation: Patient rights.
§403.732
Condition of participation: Quality assessment and performance improvement.
§403.734
Condition of participation: Food services.
§403.736
Condition of participation: Discharge planning.
§403.738
Condition of participation: Administration.
§403.740
Condition of participation: Staffing.
§403.742
Condition of participation: Physical environment.
§403.744
Condition of participation: Life safety from fire.
§403.745
Condition of participation: Building safety.
§403.746
Condition of participation: Utilization review.
§403.748
Condition of participation: Emergency preparedness.
§403.750
Estimate of expenditures and adjustments.
§403.752
Payment provisions.
§403.754
Monitoring expenditure level.
§403.756
Sunset provision.
§403.764
Basis and purpose of religious nonmedical health care institutions providing home service.
§403.766
Requirements for coverage and payment of RNHCI home services.
§403.768
Excluded services.
§403.770
Payments for home services.
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Subpart H—MEDICARE PRESCRIPTION DRUG DISCOUNT CARD AND TRANSITIONAL ASSISTANCE PROGRAM

§403.800
Basis and scope.
§403.802
Definitions.
§403.804
General rules for solicitation, application and Medicare endorsement period.
§403.806
Sponsor requirements for eligibility for endorsement.
§403.808
Use of transitional assistance funds.
§403.810
Eligibility and reconsiderations.
§403.811
Enrollment and disenrollment and associated endorsed sponsor requirements.
§403.812
HIPAA privacy, security, administrative data standards, and national identifiers.
§403.813
Marketing limitations and record retention requirements.
§403.814
Special rules concerning Part C organizations and Medicare cost plans and their enrollees.
§403.815
Special rules concerning States.
§403.816
Special rules concerning long-term care and I/T/U pharmacies.
§403.817
Special rules concerning the territories.
§403.820
Sanctions, penalties, and termination.
§403.822
Reimbursement of transitional assistance and associated sponsor requirements.
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Subpart I—TRANSPARENCY REPORTS AND REPORTING OF PHYSICIAN OWNERSHIP OR INVESTMENT INTERESTS

§403.900
Purpose and scope.
§403.902
Definitions.
§403.904
Reports of payments or other transfers of value to covered recipients.
§403.906
Reports of physician ownership and investment interests.
§403.908
Procedures for electronic submission of reports.
§403.910
Delayed publication for payments made under product research or development agreements and clinical investigations.
§403.912
Penalties for failure to report.
§403.914
Preemption of State laws.
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Subpart K—ACCESS TO IDENTIFIABLE DATA FOR THE CENTER FOR MEDICARE AND MEDICAID MODELS

§403.1100
Purpose and scope.
§403.1105
Definitions.
§403.1110
Evaluation of models.
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Subpart L—REQUIREMENTS FOR DIRECT-TO-CONSUMER TELEVISION ADVERTISEMENTS OF DRUGS AND BIOLOGICAL PRODUCTS TO INCLUDE THE LIST PRICE OF THAT ADVERTISED PRODUCT

§403.1200
Scope.
§403.1201
Definitions.
§403.1202
Pricing information.
§403.1203
Specific presentation requirements.
§403.1204
Compliance.

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