Title 42

PART 457 SUBPART L

Subpart L - Managed Care Source:81 FR 27897, May 6, 2016, unless otherwise noted.

42:4.0.1.2.15.12.175SUBJGRP 175
General Provisions
42:4.0.1.2.15.12.175.1SECTION 457.1200
   457.1200 Basis, scope, and applicability.
42:4.0.1.2.15.12.175.2SECTION 457.1201
   457.1201 Standard contract requirements.
42:4.0.1.2.15.12.175.3SECTION 457.1203
   457.1203 Rate development standards and medical loss ratio.
42:4.0.1.2.15.12.175.4SECTION 457.1206
   457.1206 Non-emergency medical transportation PAHPs.
42:4.0.1.2.15.12.175.5SECTION 457.1207
   457.1207 Information requirements.
42:4.0.1.2.15.12.175.6SECTION 457.1208
   457.1208 Provider discrimination prohibited.
42:4.0.1.2.15.12.175.7SECTION 457.1209
   457.1209 Requirements that apply to MCO, PIHP, PAHP, PCCM, and PCCM entity contracts involving Indians, Indian health care provider (IHCP), and Indian managed care entities (IMCE).
42:4.0.1.2.15.12.176SUBJGRP 176
State Responsibilities
42:4.0.1.2.15.12.176.8SECTION 457.1210
   457.1210 Enrollment process.
42:4.0.1.2.15.12.176.9SECTION 457.1212
   457.1212 Disenrollment.
42:4.0.1.2.15.12.176.10SECTION 457.1214
   457.1214 Conflict of interest safeguards.
42:4.0.1.2.15.12.176.11SECTION 457.1216
   457.1216 Continued services to enrollees.
42:4.0.1.2.15.12.176.12SECTION 457.1218
   457.1218 Network adequacy standards.
42:4.0.1.2.15.12.177SUBJGRP 177
Enrollee Rights and Protections
42:4.0.1.2.15.12.177.13SECTION 457.1220
   457.1220 Enrollee rights.
42:4.0.1.2.15.12.177.14SECTION 457.1222
   457.1222 Provider-enrollee communication.
42:4.0.1.2.15.12.177.15SECTION 457.1224
   457.1224 Marketing activities.
42:4.0.1.2.15.12.177.16SECTION 457.1226
   457.1226 Liability for payment.
42:4.0.1.2.15.12.177.17SECTION 457.1228
   457.1228 Emergency and poststabilization services.
42:4.0.1.2.15.12.178SUBJGRP 178
MCO, PIHP, and PAHP Standards
42:4.0.1.2.15.12.178.18SECTION 457.1230
   457.1230 Access standards.
42:4.0.1.2.15.12.178.19SECTION 457.1233
   457.1233 Structure and operation standards.
42:4.0.1.2.15.12.179SUBJGRP 179
Quality Measurement and Improvement; External Quality Review
42:4.0.1.2.15.12.179.20SECTION 457.1240
   457.1240 Quality measurement and improvement.
42:4.0.1.2.15.12.179.21SECTION 457.1250
   457.1250 External quality review.
42:4.0.1.2.15.12.180SUBJGRP 180
Grievance System
42:4.0.1.2.15.12.180.22SECTION 457.1260
   457.1260 Grievance system.
42:4.0.1.2.15.12.181SUBJGRP 181
Sanctions
42:4.0.1.2.15.12.181.23SECTION 457.1270
   457.1270 Sanctions.
42:4.0.1.2.15.12.181.24SECTION 457.1280
   457.1280 Conditions necessary to contract as an MCO, PAHP, or PIHP.
42:4.0.1.2.15.12.181.25SECTION 457.1285
   457.1285 Program integrity safeguards.