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