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Title 42 Chapter IV

Title 42 → Chapter IV

Electronic Code of Federal Regulations e-CFR

Title 42 Chapter IV

Title 42 → Chapter IV


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

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PartTable of
Contents
Headings
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SUBCHAPTER A—GENERAL PROVISIONS

400
400.200 to 400.203
INTRODUCTION; DEFINITIONS
401
401.101 to 401.722
GENERAL ADMINISTRATIVE REQUIREMENTS
402
402.1 to 402.308
CIVIL MONEY PENALTIES, ASSESSMENTS, AND EXCLUSIONS
403
403.200 to 403.1204
SPECIAL PROGRAMS AND PROJECTS
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SUBCHAPTER B—MEDICARE PROGRAM

405
405.201 to 405.2472
FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
406
406.1 to 406.52
HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT
407
407.1 to 407.50
SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND ENTITLEMENT
408
408.1 to 408.210
PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE
409
409.1 to 409.102
HOSPITAL INSURANCE BENEFITS
410
410.1 to 410.175
SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
411
411.1 to 411.408
EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT
412
412.1 to 412.634
PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES
413
413.1 to 413.375
PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES; PAYMENT FOR ACUTE KIDNEY INJURY DIALYSIS
414
414.1 to 414.1465
PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
415
415.1 to 415.208
SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS
416
416.1 to 416.330
AMBULATORY SURGICAL SERVICES
417
417.1 to 417.940
HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS
418
418.1 to 418.405
HOSPICE CARE
419
419.1 to 419.71
PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES
420
420.1 to 420.410
PROGRAM INTEGRITY: MEDICARE
421
421.1 to 421.404
MEDICARE CONTRACTING
422
422.1 to 422.2615
MEDICARE ADVANTAGE PROGRAM
423
423.1 to 423.2615
VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
424
424.1 to 424.570
CONDITIONS FOR MEDICARE PAYMENT
425
425.10 to 425.810
MEDICARE SHARED SAVINGS PROGRAM
426
426.100 to 426.587
REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS
427-429
[RESERVED]
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SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS

430
430.0 to 430.104
GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
431
431.1 to 431.1010
STATE ORGANIZATION AND GENERAL ADMINISTRATION
432
432.1 to 432.55
STATE PERSONNEL ADMINISTRATION
433
433.1 to 433.322
STATE FISCAL ADMINISTRATION
434
434.1 to 434.78
CONTRACTS
435
435.2 to 435.1205
ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA
436
436.1 to 436.1102
ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS
438
438.1 to 438.930
MANAGED CARE
440
440.1 to 440.395
SERVICES: GENERAL PROVISIONS
441
441.1 to 441.745
SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES
442
442.1 to 442.119
STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES
447
447.1 to 447.522
PAYMENTS FOR SERVICES
455
455.1 to 455.518
PROGRAM INTEGRITY: MEDICAID
456
456.1 to 456.725
UTILIZATION CONTROL
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SUBCHAPTER D—STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs)

457
457.1 to 457.1285
ALLOTMENTS AND GRANTS TO STATES
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SUBCHAPTER E—PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)

460
460.2 to 460.210
PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
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SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS

475
475.1 to 475.107
QUALITY IMPROVEMENT ORGANIZATIONS
476
476.1 to 476.170
QUALITY IMPROVEMENT ORGANIZATION REVIEW
478
478.10 to 478.48
RECONSIDERATIONS AND APPEALS
480
480.101 to 480.145
ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION
481
[RESERVED]
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SUBCHAPTER G—STANDARDS AND CERTIFICATION

482
482.1 to 482.104
CONDITIONS OF PARTICIPATION FOR HOSPITALS
483
483.1 to 483.480
REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES
484
484.1 to 484.335
HOME HEALTH SERVICES
485
485.50 to 485.920
CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS
486
486.1 to 486.525
CONDITIONS FOR COVERAGE OF SPECIALIZED SERVICES FURNISHED BY SUPPLIERS
488
488.1 to 488.1050
SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES
489
489.1 to 489.104
PROVIDER AGREEMENTS AND SUPPLIER APPROVAL
491
491.1 to 491.12
CERTIFICATION OF CERTAIN HEALTH FACILITIES
493
493.1 to 493.2001
LABORATORY REQUIREMENTS
494
494.1 to 494.180
CONDITIONS FOR COVERAGE FOR END-STAGE RENAL DISEASE FACILITIES
495
495.2 to 495.370
STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM
498
498.1 to 498.103
APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT PARTICIPATION IN THE MEDICARE PROGRAM AND FOR DETERMINATIONS THAT AFFECT THE PARTICIPATION OF ICFs/IID AND CERTAIN NFs IN THE MEDICAID PROGRAM
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SUBCHAPTER H—HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS

505
505.1 to 505.19
ESTABLISHMENT OF THE HEALTH CARE INFRASTRUCTURE IMPROVEMENT PROGRAM
510
510.1 to 510.900
COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL
512
[RESERVED]
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SUBCHAPTER I—BASIC HEALTH PROGRAM

600
600.1 to 600.715
ADMINISTRATION, ELIGIBILITY, ESSENTIAL HEALTH BENEFITS, PERFORMANCE STANDARDS, SERVICE DELIVERY REQUIREMENTS, PREMIUM AND COST SHARING, ALLOTMENTS, AND RECONCILATION
601-699
[RESERVED]