Title 42

PART 457 SUBPART l

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

• 42 U.S.C. 1302.
• Source: 65 FR 33622, May 24, 2000, unless otherwise noted.

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.

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