Title 42

Volume 4 CHAPTER IV

Chapter Iv - Centers For Medicare & Medicaid Services, Department Of Health And Human Services (continued)

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

42:4.0.1.1SUBCHAP C
SUBCHAPTER C - MEDICAL ASSISTANCE PROGRAMS
42:4.0.1.1.1PART 430
   PART 430 - GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
42:4.0.1.1.2PART 431
   PART 431 - STATE ORGANIZATION AND GENERAL ADMINISTRATION
42:4.0.1.1.2.5.8SUBJGRP 8
      General Provisions
42:4.0.1.1.2.5.9SUBJGRP 9
      Notice
42:4.0.1.1.2.5.10SUBJGRP 10
      Right to Hearing
42:4.0.1.1.2.5.11SUBJGRP 11
      Procedures
42:4.0.1.1.2.5.12SUBJGRP 12
      Federal Financial Participation
42:4.0.1.1.2.12.13SUBJGRP 13
      Medicaid Eligibility Quality Control (MEQC) Program
42:4.0.1.1.2.12.14SUBJGRP 14
      Medicaid Quality Control (MQC) Claims Processing Assessment System
42:4.0.1.1.3PART 432
   PART 432 - STATE PERSONNEL ADMINISTRATION
42:4.0.1.1.4PART 433
   PART 433 - STATE FISCAL ADMINISTRATION
42:4.0.1.1.4.4.17SUBJGRP 17
      Assignment of Rights to Benefits
42:4.0.1.1.4.4.18SUBJGRP 18
      Cooperative Agreements and Incentive Payments
42:4.0.1.1.5PART 434
   PART 434 - CONTRACTS
42:4.0.1.1.6PART 435
   PART 435 - ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA
42:4.0.1.1.6.2.48SUBJGRP 48
      Mandatory Coverage of Families and Children
42:4.0.1.1.6.2.49SUBJGRP 49
      Mandatory Coverage of Pregnant Women, Children Under 19, and Newborn Children
42:4.0.1.1.6.2.50SUBJGRP 50
      Mandatory Coverage of Qualified Family Members
42:4.0.1.1.6.2.51SUBJGRP 51
      Mandatory Coverage for Individuals Age 19 Through 64
42:4.0.1.1.6.2.52SUBJGRP 52
      Mandatory Coverage of the Aged, Blind, and Disabled
42:4.0.1.1.6.2.53SUBJGRP 53
      Mandatory Coverage of Certain Aliens
42:4.0.1.1.6.2.54SUBJGRP 54
      Mandatory Coverage of Adoption Assistance and Foster Care Children
42:4.0.1.1.6.2.55SUBJGRP 55
      Mandatory Coverage of Special Groups
42:4.0.1.1.6.3.56SUBJGRP 56
      Options for Coverage of Families and Children and the Aged, Blind, and Disabled
42:4.0.1.1.6.3.57SUBJGRP 57
      Options for Coverage of Families and Children
42:4.0.1.1.6.3.58SUBJGRP 58
      Options for Coverage of the Aged, Blind, and Disabled
42:4.0.1.1.6.6.59SUBJGRP 59
      Age
42:4.0.1.1.6.6.60SUBJGRP 60
      Blindness
42:4.0.1.1.6.6.61SUBJGRP 61
      Disability
42:4.0.1.1.6.9.62SUBJGRP 62
      Medically Needy Income Standard
42:4.0.1.1.6.9.63SUBJGRP 63
      Medically Needy Income Eligibility
42:4.0.1.1.6.9.64SUBJGRP 64
      Medically Needy Resource Standard
42:4.0.1.1.6.9.65SUBJGRP 65
      Determining Eligibility on the Basis of Resources
42:4.0.1.1.6.10.66SUBJGRP 66
      General Methods of Administration
42:4.0.1.1.6.10.67SUBJGRP 67
      Applications
42:4.0.1.1.6.10.68SUBJGRP 68
      Determination of Medicaid Eligibility
42:4.0.1.1.6.10.69SUBJGRP 69
      Redeterminations of Medicaid Eligibility
42:4.0.1.1.6.10.70SUBJGRP 70
      Furnishing Medicaid
42:4.0.1.1.6.10.71SUBJGRP 71
      Income and Eligibility Verification Requirements
42:4.0.1.1.6.11.72SUBJGRP 72
      FFP in Expenditures for Determining Eligibility and Providing Services
42:4.0.1.1.6.11.73SUBJGRP 73
      Limitations on FFP
42:4.0.1.1.6.11.74SUBJGRP 74
      Requirements for State Supplements
42:4.0.1.1.6.11.75SUBJGRP 75
      FFP for Premium Assistance
42:4.0.1.1.7PART 436
   PART 436 - ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS
42:4.0.1.1.7.3.88SUBJGRP 88
      Options for Coverage of Families and Children and Aged, Blind, and Disabled Individuals, Including Pregnant Women
42:4.0.1.1.7.3.89SUBJGRP 89
      Options for Coverage of the Aged, Blind, and Disabled
42:4.0.1.1.7.6.90SUBJGRP 90
      Dependency
42:4.0.1.1.7.6.91SUBJGRP 91
      Age
42:4.0.1.1.7.6.92SUBJGRP 92
      Blindness
42:4.0.1.1.7.6.93SUBJGRP 93
      Disability
42:4.0.1.1.7.9.94SUBJGRP 94
      Medically Needy Income Standard
42:4.0.1.1.7.9.95SUBJGRP 95
      Medically Needy Income Eligibility and Liability for Payment of Medical Expenses
42:4.0.1.1.7.9.96SUBJGRP 96
      Medically Needy Resource Standard
42:4.0.1.1.7.9.97SUBJGRP 97
      Determining Eligibility on the Basis of Resources
42:4.0.1.1.7.11.98SUBJGRP 98
      FFP for Expenditures for Determining Eligibility and Providing Services
42:4.0.1.1.7.12.99SUBJGRP 99
      Presumptive Eligibility for Children
42:4.0.1.1.8PART 438
   PART 438 - MANAGED CARE
42:4.0.1.1.9PART 440
   PART 440 - SERVICES: GENERAL PROVISIONS
42:4.0.1.1.10PART 441
   PART 441 - SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES
42:4.0.1.1.11PART 442
   PART 442 - STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES
42:4.0.1.1.12PART 447
   PART 447 - PAYMENTS FOR SERVICES
42:4.0.1.1.12.1.109SUBJGRP 109
      Medicaid Premiums and Cost Sharing
42:4.0.1.1.12.3.110SUBJGRP 110
      Payment Rates
42:4.0.1.1.12.3.111SUBJGRP 111
      Federal Financial Participation
42:4.0.1.1.12.3.112SUBJGRP 112
      Upper Limits
42:4.0.1.1.12.3.113SUBJGRP 113
      Swing-Bed Hospitals
42:4.0.1.1.12.6.114SUBJGRP 114
      Outpatient Hospital and Clinic Services
42:4.0.1.1.12.6.115SUBJGRP 115
      Other Inpatient and Outpatient Facilities
42:4.0.1.1.12.6.116SUBJGRP 116
      Prepaid Capitation Plans
42:4.0.1.1.12.6.117SUBJGRP 117
      Rural Health Clinic Services
42:4.0.1.1.13PART 455
   PART 455 - PROGRAM INTEGRITY: MEDICAID
42:4.0.1.1.14PART 456
   PART 456 - UTILIZATION CONTROL
42:4.0.1.1.14.3.143SUBJGRP 143
      Certification of Need for Care
42:4.0.1.1.14.3.144SUBJGRP 144
      Plan of Care
42:4.0.1.1.14.3.145SUBJGRP 145
      Utilization Review (UR) Plan: General Requirement
42:4.0.1.1.14.3.146SUBJGRP 146
      UR Plan: Administrative Requirements
42:4.0.1.1.14.3.147SUBJGRP 147
      UR Plan: Informational Requirements
42:4.0.1.1.14.3.148SUBJGRP 148
      UR Plan: Review of Need for Admission 1 />
42:4.0.1.1.14.3.149SUBJGRP 149
      UR Plan: Review of Need for Continued Stay
42:4.0.1.1.14.3.150SUBJGRP 150
      UR Plan: Medical Care Evaluation Studies
42:4.0.1.1.14.4.151SUBJGRP 151
      Certification of Need for Care
42:4.0.1.1.14.4.152SUBJGRP 152
      Medical, Psychiatric, and Social Evaluations and Admission Review
42:4.0.1.1.14.4.153SUBJGRP 153
      Plan of Care
42:4.0.1.1.14.4.154SUBJGRP 154
      Utilization Review (UR) Plan: General Requirements
42:4.0.1.1.14.4.155SUBJGRP 155
      UR Plan: Administrative Requirements
42:4.0.1.1.14.4.156SUBJGRP 156
      UR Plan: Informational Requirements
42:4.0.1.1.14.4.157SUBJGRP 157
      UR Plan: Review of Need for Continued Stay
42:4.0.1.1.14.4.158SUBJGRP 158
      UR Plan: Medical Care Evaluation Studies
42:4.0.1.1.14.6.159SUBJGRP 159
      Certification of Need for Care
42:4.0.1.1.14.6.160SUBJGRP 160
      Medical, Psychological, and Social Evaluations and Admission Review
42:4.0.1.1.14.6.161SUBJGRP 161
      Plan of Care
42:4.0.1.1.14.6.162SUBJGRP 162
      Utilization Review (UR) Plan: General Requirement
42:4.0.1.1.14.6.163SUBJGRP 163
      UR Plan: Administrative Requirements
42:4.0.1.1.14.6.164SUBJGRP 164
      UR Plan: Informational Requirements
42:4.0.1.1.14.6.165SUBJGRP 165
      UR Plan: Review of Need for Continued Stay
42:4.0.1.1.14.8.166SUBJGRP 166
      UR Plan: Waiver of Requirements
42:4.0.1.1.14.8.167SUBJGRP 167
      UR Plan: Remote Facility Variances from Time Requirements
42:4.0.1.2SUBCHAP D
SUBCHAPTER D - STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs)
42:4.0.1.2.15PART 457
   PART 457 - ALLOTMENTS AND GRANTS TO STATES
42:4.0.1.2.15.12.175SUBJGRP 175
      General Provisions
42:4.0.1.2.15.12.176SUBJGRP 176
      State Responsibilities
42:4.0.1.2.15.12.177SUBJGRP 177
      Enrollee Rights and Protections
42:4.0.1.2.15.12.178SUBJGRP 178
      MCO, PIHP, and PAHP Standards
42:4.0.1.2.15.12.179SUBJGRP 179
      Quality Measurement and Improvement; External Quality Review
42:4.0.1.2.15.12.180SUBJGRP 180
      Grievance System
42:4.0.1.2.15.12.181SUBJGRP 181
      Sanctions
42:4.0.1.3SUBCHAP E
SUBCHAPTER E - PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
42:4.0.1.3.16PART 460
   PART 460 - PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
42:4.0.1.4SUBCHAP F
SUBCHAPTER F - QUALITY IMPROVEMENT ORGANIZATIONS
42:4.0.1.4.17PART 475
   PART 475 - QUALITY IMPROVEMENT ORGANIZATIONS
42:4.0.1.4.18PART 476
   PART 476 - QUALITY IMPROVEMENT ORGANIZATION REVIEW
42:4.0.1.4.18.3.184SUBJGRP 184
      General Provisions
42:4.0.1.4.18.3.185SUBJGRP 185
      QIO Review Functions
42:4.0.1.4.19PART 478
   PART 478 - RECONSIDERATIONS AND APPEALS
42:4.0.1.4.20PART 480
   PART 480 - ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION
42:4.0.1.4.20.2.191SUBJGRP 191
      General Provisions
42:4.0.1.4.20.2.192SUBJGRP 192
      QIO Access to Information
42:4.0.1.4.20.2.193SUBJGRP 193
      QIO Responsibilities
42:4.0.1.4.20.2.194SUBJGRP 194
      Disclosure of Nonconfidential Information
42:4.0.1.4.20.2.195SUBJGRP 195
      Disclosure of Confidential Information
42:4.0.1.4.21PART 481
   PART 481 [RESERVED]