Title 42

PART 431

Part 431 - State Organization And General Administration

PART 431 - STATE ORGANIZATION AND GENERAL ADMINISTRATION Authority:42 U.S.C. 1302. Source:43 FR 45188, Sept. 29, 1978, unless otherwise noted. Editorial Note:Nomenclature changes to part 431 appear at 75 FR 48852, Aug. 11, 2010.

• Authority: 42 U.S.C. 1302.
• Source: 43 FR 45188, Sept. 29, 1978, unless otherwise noted.

42:4.0.1.1.2.0.8.1	SECTION 431.1	431.1 Purpose.
42:4.0.1.1.2.1	SUBPART A	Subpart A - Single State Agency
42:4.0.1.1.2.1.8.1	SECTION 431.10	431.10 Single State agency.
42:4.0.1.1.2.1.8.2	SECTION 431.11	431.11 Organization for administration.
42:4.0.1.1.2.1.8.3	SECTION 431.12	431.12 Medical care advisory committee.
42:4.0.1.1.2.1.8.4	SECTION 431.15	431.15 Methods of administration.
42:4.0.1.1.2.1.8.5	SECTION 431.16	431.16 Reports.
42:4.0.1.1.2.1.8.6	SECTION 431.17	431.17 Maintenance of records.
42:4.0.1.1.2.1.8.7	SECTION 431.18	431.18 Availability of agency program manuals.
42:4.0.1.1.2.1.8.8	SECTION 431.20	431.20 Advance directives.
42:4.0.1.1.2.2	SUBPART B	Subpart B - General Administrative Requirements
42:4.0.1.1.2.2.8.1	SECTION 431.40	431.40 Basis and scope.
42:4.0.1.1.2.2.8.2	SECTION 431.50	431.50 Statewide operation.
42:4.0.1.1.2.2.8.3	SECTION 431.51	431.51 Free choice of providers.
42:4.0.1.1.2.2.8.4	SECTION 431.52	431.52 Payments for services furnished out of State.
42:4.0.1.1.2.2.8.5	SECTION 431.53	431.53 Assurance of transportation.
42:4.0.1.1.2.2.8.6	SECTION 431.54	431.54 Exceptions to certain State plan requirements.
42:4.0.1.1.2.2.8.7	SECTION 431.55	431.55 Waiver of other Medicaid requirements.
42:4.0.1.1.2.2.8.8	SECTION 431.56	431.56 Special waiver provisions applicable to American Samoa and the Northern Mariana Islands.
42:4.0.1.1.2.2.8.9	SECTION 431.60	431.60 Beneficiary access to and exchange of data.
42:4.0.1.1.2.2.8.10	SECTION 431.70	431.70 Access to published provider directory information.
42:4.0.1.1.2.3	SUBPART C	Subpart C - Administrative Requirements: Provider Relations
42:4.0.1.1.2.3.8.1	SECTION 431.105	431.105 Consultation to medical facilities.
42:4.0.1.1.2.3.8.2	SECTION 431.107	431.107 Required provider agreement.
42:4.0.1.1.2.3.8.3	SECTION 431.108	431.108 Effective date of provider agreements.
42:4.0.1.1.2.3.8.4	SECTION 431.110	431.110 Participation by Indian Health Service facilities.
42:4.0.1.1.2.3.8.5	SECTION 431.115	431.115 Disclosure of survey information and provider or contractor evaluation.
42:4.0.1.1.2.3.8.6	SECTION 431.120	431.120 State requirements with respect to nursing facilities.
42:4.0.1.1.2.4	SUBPART D	Subpart D - Appeals Process for NFs and ICFs/IID
42:4.0.1.1.2.4.8.1	SECTION 431.151	431.151 Scope and applicability.
42:4.0.1.1.2.4.8.2	SECTION 431.152	431.152 State plan requirements.
42:4.0.1.1.2.4.8.3	SECTION 431.153	431.153 Evidentiary hearing.
42:4.0.1.1.2.4.8.4	SECTION 431.154	431.154 Informal reconsideration for ICFs/IID.
42:4.0.1.1.2.5	SUBPART E	Subpart E - Fair Hearings for Applicants and Beneficiaries
42:4.0.1.1.2.5.8	SUBJGRP 8	General Provisions
42:4.0.1.1.2.5.8.1	SECTION 431.200	431.200 Basis and scope.
42:4.0.1.1.2.5.8.2	SECTION 431.201	431.201 Definitions.
42:4.0.1.1.2.5.8.3	SECTION 431.202	431.202 State plan requirements.
42:4.0.1.1.2.5.8.4	SECTION 431.205	431.205 Provision of hearing system.
42:4.0.1.1.2.5.8.5	SECTION 431.206	431.206 Informing applicants and beneficiaries.
42:4.0.1.1.2.5.9	SUBJGRP 9	Notice
42:4.0.1.1.2.5.9.6	SECTION 431.210	431.210 Content of notice.
42:4.0.1.1.2.5.9.7	SECTION 431.211	431.211 Advance notice.
42:4.0.1.1.2.5.9.8	SECTION 431.213	431.213 Exceptions from advance notice.
42:4.0.1.1.2.5.9.9	SECTION 431.214	431.214 Notice in cases of probable fraud.
42:4.0.1.1.2.5.10	SUBJGRP 10	Right to Hearing
42:4.0.1.1.2.5.10.10	SECTION 431.220	431.220 When a hearing is required.
42:4.0.1.1.2.5.10.11	SECTION 431.221	431.221 Request for hearing.
42:4.0.1.1.2.5.10.12	SECTION 431.222	431.222 Group hearings.
42:4.0.1.1.2.5.10.13	SECTION 431.223	431.223 Denial or dismissal of request for a hearing.
42:4.0.1.1.2.5.10.14	SECTION 431.224	431.224 Expedited appeals.
42:4.0.1.1.2.5.11	SUBJGRP 11	Procedures
42:4.0.1.1.2.5.11.15	SECTION 431.230	431.230 Maintaining services.
42:4.0.1.1.2.5.11.16	SECTION 431.231	431.231 Reinstating services.
42:4.0.1.1.2.5.11.17	SECTION 431.232	431.232 Adverse decision of local evidentiary hearing.
42:4.0.1.1.2.5.11.18	SECTION 431.233	431.233 State agency hearing after adverse decision of local evidentiary hearing.
42:4.0.1.1.2.5.11.19	SECTION 431.240	431.240 Conducting the hearing.
42:4.0.1.1.2.5.11.20	SECTION 431.241	431.241 Matters to be considered at the hearing.
42:4.0.1.1.2.5.11.21	SECTION 431.242	431.242 Procedural rights of the applicant or beneficiary.
42:4.0.1.1.2.5.11.22	SECTION 431.243	431.243 Parties in cases involving an eligibility determination.
42:4.0.1.1.2.5.11.23	SECTION 431.244	431.244 Hearing decisions.
42:4.0.1.1.2.5.11.24	SECTION 431.245	431.245 Notifying the applicant or beneficiary of a State agency decision.
42:4.0.1.1.2.5.11.25	SECTION 431.246	431.246 Corrective action.
42:4.0.1.1.2.5.12	SUBJGRP 12	Federal Financial Participation
42:4.0.1.1.2.5.12.26	SECTION 431.250	431.250 Federal financial participation.
42:4.0.1.1.2.6	SUBPART F	Subpart F - Safeguarding Information on Applicants and Beneficiaries
42:4.0.1.1.2.6.13.1	SECTION 431.300	431.300 Basis and purpose.
42:4.0.1.1.2.6.13.2	SECTION 431.301	431.301 State plan requirements.
42:4.0.1.1.2.6.13.3	SECTION 431.302	431.302 Purposes directly related to State plan administration.
42:4.0.1.1.2.6.13.4	SECTION 431.303	431.303 State authority for safeguarding information.
42:4.0.1.1.2.6.13.5	SECTION 431.304	431.304 Publicizing safeguarding requirements.
42:4.0.1.1.2.6.13.6	SECTION 431.305	431.305 Types of information to be safeguarded.
42:4.0.1.1.2.6.13.7	SECTION 431.306	431.306 Release of information.
42:4.0.1.1.2.6.13.8	SECTION 431.307	431.307 Distribution of information materials.
42:4.0.1.1.2.7	SUBPART G	Subpart G - Section 1115 Demonstrations
42:4.0.1.1.2.7.13.1	SECTION 431.400	431.400 Basis and purpose.
42:4.0.1.1.2.7.13.2	SECTION 431.404	431.404 Definitions.
42:4.0.1.1.2.7.13.3	SECTION 431.408	431.408 State public notice process.
42:4.0.1.1.2.7.13.4	SECTION 431.412	431.412 Application procedures.
42:4.0.1.1.2.7.13.5	SECTION 431.416	431.416 Federal public notice and approval process.
42:4.0.1.1.2.7.13.6	SECTION 431.420	431.420 Monitoring and compliance.
42:4.0.1.1.2.7.13.7	SECTION 431.424	431.424 Evaluation requirements.
42:4.0.1.1.2.7.13.8	SECTION 431.428	431.428 Reporting requirements.
42:4.0.1.1.2.8	SUBPART H	Subparts H-L [Reserved]
42:4.0.1.1.2.9	SUBPART M	Subpart M - Relations With Other Agencies
42:4.0.1.1.2.9.13.1	SECTION 431.610	431.610 Relations with standard-setting and survey agencies.
42:4.0.1.1.2.9.13.2	SECTION 431.615	431.615 Relations with State health and vocational rehabilitation agencies and title V grantees.
42:4.0.1.1.2.9.13.3	SECTION 431.620	431.620 Agreement with State mental health authority or mental institutions.
42:4.0.1.1.2.9.13.4	SECTION 431.621	431.621 State requirements with respect to nursing facilities.
42:4.0.1.1.2.9.13.5	SECTION 431.625	431.625 Coordination of Medicaid with Medicare part B.
42:4.0.1.1.2.9.13.6	SECTION 431.630	431.630 Coordination of Medicaid with QIOs.
42:4.0.1.1.2.9.13.7	SECTION 431.635	431.635 Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children (WIC).
42:4.0.1.1.2.10	SUBPART N	Subpart N - State Programs for Licensing Nursing Home Administrators
42:4.0.1.1.2.10.13.1	SECTION 431.700	431.700 Basis and purpose.
42:4.0.1.1.2.10.13.2	SECTION 431.701	431.701 Definitions.
42:4.0.1.1.2.10.13.3	SECTION 431.702	431.702 State plan requirement.
42:4.0.1.1.2.10.13.4	SECTION 431.703	431.703 Licensing requirement.
42:4.0.1.1.2.10.13.5	SECTION 431.704	431.704 Nursing homes designated by other terms.
42:4.0.1.1.2.10.13.6	SECTION 431.705	431.705 Licensing authority.
42:4.0.1.1.2.10.13.7	SECTION 431.706	431.706 Composition of licensing board.
42:4.0.1.1.2.10.13.8	SECTION 431.707	431.707 Standards.
42:4.0.1.1.2.10.13.9	SECTION 431.708	431.708 Procedures for applying standards.
42:4.0.1.1.2.10.13.10	SECTION 431.709	431.709 Issuance and revocation of license.
42:4.0.1.1.2.10.13.11	SECTION 431.710	431.710 Provisional licenses.
42:4.0.1.1.2.10.13.12	SECTION 431.711	431.711 Compliance with standards.
42:4.0.1.1.2.10.13.13	SECTION 431.712	431.712 Failure to comply with standards.
42:4.0.1.1.2.10.13.14	SECTION 431.713	431.713 Continuing study and investigation.
42:4.0.1.1.2.10.13.15	SECTION 431.714	431.714 Waivers.
42:4.0.1.1.2.10.13.16	SECTION 431.715	431.715 Federal financial participation.
42:4.0.1.1.2.11	SUBPART O	Subpart O [Reserved]
42:4.0.1.1.2.12	SUBPART P	Subpart P - Quality Control
42:4.0.1.1.2.12.13	SUBJGRP 13	Medicaid Eligibility Quality Control (MEQC) Program
42:4.0.1.1.2.12.13.1	SECTION 431.800	431.800 Basis and scope.
42:4.0.1.1.2.12.13.2	SECTION 431.804	431.804 Definitions.
42:4.0.1.1.2.12.13.3	SECTION 431.806	431.806 State requirements.
42:4.0.1.1.2.12.13.4	SECTION 431.808	431.808 Protection of beneficiary rights.
42:4.0.1.1.2.12.13.5	SECTION 431.810	431.810 Basic elements of the Medicaid Eligibility Quality Control (MEQC) Program.
42:4.0.1.1.2.12.13.6	SECTION 431.812	431.812 Review procedures.
42:4.0.1.1.2.12.13.7	SECTION 431.814	431.814 Pilot planning document.
42:4.0.1.1.2.12.13.8	SECTION 431.816	431.816 Case review completion deadlines and submittal of reports.
42:4.0.1.1.2.12.13.9	SECTION 431.818	431.818 Access to records.
42:4.0.1.1.2.12.13.10	SECTION 431.820	431.820 Corrective action under the MEQC program.
42:4.0.1.1.2.12.14	SUBJGRP 14	Medicaid Quality Control (MQC) Claims Processing Assessment System
42:4.0.1.1.2.12.14.11	SECTION 431.830	431.830 Basic elements of the Medicaid quality control (MQC) claims processing assessment system.
42:4.0.1.1.2.12.14.12	SECTION 431.832	431.832 Reporting requirements for claims processing assessment systems.
42:4.0.1.1.2.12.14.13	SECTION 431.834	431.834 Access to records: Claims processing assessment systems.
42:4.0.1.1.2.12.14.14	SECTION 431.836	431.836 Corrective action under the MQC claims processing assessment system.
42:4.0.1.1.2.13	SUBPART Q	Subpart Q - Requirements for Estimating Improper Payments in Medicaid and CHIP
42:4.0.1.1.2.13.15.1	SECTION 431.950	431.950 Purpose.
42:4.0.1.1.2.13.15.2	SECTION 431.954	431.954 Basis and scope.
42:4.0.1.1.2.13.15.3	SECTION 431.958	431.958 Definitions and use of terms.
42:4.0.1.1.2.13.15.4	SECTION 431.960	431.960 Types of payment errors.
42:4.0.1.1.2.13.15.5	SECTION 431.970	431.970 Information submission and systems access requirements.
42:4.0.1.1.2.13.15.6	SECTION 431.972	431.972 Claims sampling procedures.
42:4.0.1.1.2.13.15.7	SECTION 431.992	431.992 Corrective action plan.
42:4.0.1.1.2.13.15.8	SECTION 431.998	431.998 Difference resolution and appeal process.
42:4.0.1.1.2.13.15.9	SECTION 431.1002	431.1002 Recoveries.
42:4.0.1.1.2.13.15.10	SECTION 431.1010	431.1010 Disallowance of Federal financial participation for erroneous State payments (for PERM review years ending after July 1, 2020).

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