Title 42

PART 403

Part 403 - Special Programs And Projects

PART 403 - SPECIAL PROGRAMS AND PROJECTS Authority:42 U.S.C. 1302, and 1395hh. Authority:42 U.S.C. 1302 and 1395hh.

• Authority: 42 U.S.C. 1302, and 1395hh.

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.

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