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- 42 CFR 420.400 · Basis and scope.
- 42 CFR 420.405 · Rewards for information relating to Medicare fraud and abuse.
- 42 CFR 420.410 · Establishment of a program to collect suggestions for improving Medicare program efficiency and to reward suggesters for monetary savings.
- 42 CFR 421.1 · Basis, applicability, and scope.
- 42 CFR 421.3 · Definitions.
- 42 CFR 421.5 · General provisions.
- 42 CFR 421.100 · Intermediary functions.
- 42 CFR 421.103 · Payment to providers.
- 42 CFR 421.104 · Assignment of providers of services to intermediaries during transition to Medicare Administrative Contractors (MACs).
- 42 CFR 421.110 · Requirements for approval of an agreement.
- 42 CFR 421.112 · Considerations relating to the effective and efficient administration of the program.
- 42 CFR 421.114 · Assignment and reassignment of providers by CMS.
- 42 CFR 421.120 · Performance criteria.
- 42 CFR 421.122 · Performance standards.
- 42 CFR 421.124 · Intermediary's failure to perform efficiently and effectively.
- 42 CFR 421.126 · Termination of agreements.
- 42 CFR 421.128 · Intermediary's opportunity for hearing and right to judicial review.
- 42 CFR 421.200 · Carrier functions.
- 42 CFR 421.201 · Performance criteria and standards.
- 42 CFR 421.202 · Requirements and conditions.
- 42 CFR 421.203 · Carrier's failure to perform efficiently and effectively.
- 42 CFR 421.205 · Termination by the Secretary.
- 42 CFR 421.210 · Designations of regional carriers to process claims for durable medical equipment, prosthetics, orthotics and supplies.
- 42 CFR 421.212 · Railroad Retirement Board contracts.
- 42 CFR 421.214 · Advance payments to suppliers furnishing items or services under Part B.
- 42 CFR 421.300 · Basis, applicability, and scope.
- 42 CFR 421.302 · Eligibility requirements for Medicare integrity program contractors.
- 42 CFR 421.304 · Medicare integrity program contractor functions.
- 42 CFR 421.306 · Awarding of a contract.
- 42 CFR 421.308 · Renewal of a contract.
- 42 CFR 421.310 · Conflict of interest requirements.
- 42 CFR 421.312 · Conflict of interest resolution.
- 42 CFR 421.316 · Limitation on Medicare integrity program contractor liability.
- 42 CFR 421.400 · Statutory basis and scope.
- 42 CFR 421.401 · Definitions.
- 42 CFR 421.404 · Assignment of providers and suppliers to MACs.
- 42 CFR 422.1 · Basis and scope.
- 42 CFR 422.2 · Definitions.
- 42 CFR 422.3 · MA organizations' use of reinsurance.
- 42 CFR 422.4 · Types of MA plans.
- 42 CFR 422.6 · Cost-sharing in enrollment-related costs.
- 42 CFR 422.50 · Eligibility to elect an MA plan.
- 42 CFR 422.52 · Eligibility to elect an MA plan for special needs individuals.
- 42 CFR 422.53 · Eligibility to elect an MA plan for senior housing facility residents.
- 42 CFR 422.54 · Continuation of enrollment for MA local plans.
- 42 CFR 422.56 · Enrollment in an MA MSA plan.
- 42 CFR 422.57 · Limited enrollment under MA RFB plans.
- 42 CFR 422.60 · Election process.
- 42 CFR 422.62 · Election of coverage under an MA plan.
- 42 CFR 422.64 · Information about the MA program.
- 42 CFR 422.66 · Coordination of enrollment and disenrollment through MA organizations.
- 42 CFR 422.68 · Effective dates of coverage and change of coverage.
- 42 CFR 422.74 · Disenrollment by the MA organization.
- 42 CFR 422.100 · General requirements.
- 42 CFR 422.101 · Requirements relating to basic benefits.
- 42 CFR 422.102 · Supplemental benefits.
- 42 CFR 422.103 · Benefits under an MA MSA plan.
- 42 CFR 422.104 · Special rules on supplemental benefits for MA MSA plans.
- 42 CFR 422.105 · Special rules for self-referral and point of service option.
- 42 CFR 422.106 · Coordination of benefits with employer or union group health plans and Medicaid.
- 42 CFR 422.107 · Requirements for dual eligible special needs plans.
- 42 CFR 422.108 · Medicare secondary payer (MSP) procedures.
- 42 CFR 422.109 · Effect of national coverage determinations (NCDs) and legislative changes in benefits; coverage of clinical trials and A and B device trials.
- 42 CFR 422.110 · Discrimination against beneficiaries prohibited.
- 42 CFR 422.111 · Disclosure requirements.
- 42 CFR 422.112 · Access to services.
- 42 CFR 422.113 · Special rules for ambulance services, emergency and urgently needed services, and maintenance and post-stabilization care services.
- 42 CFR 422.114 · Access to services under an MA private fee-for-service plan.
- 42 CFR 422.116 · Network adequacy.
- 42 CFR 422.118 · Confidentiality and accuracy of enrollee records.
- 42 CFR 422.119 · Access to and exchange of health data and plan information.
- 42 CFR 422.120 · Access to published provider directory information.
- 42 CFR 422.121 · Access to and exchange of health data for providers and payers.
- 42 CFR 422.122 · Prior authorization requirements.
- 42 CFR 422.125 · Resolution of complaints in a Complaints Tracking Module.
- 42 CFR 422.128 · Information on advance directives.
- 42 CFR 422.132 · Protection against liability and loss of benefits.
- 42 CFR 422.133 · Return to home skilled nursing facility.
- 42 CFR 422.134 · Reward and incentive programs.
- 42 CFR 422.135 · Additional telehealth benefits.
- 42 CFR 422.136 · Medicare Advantage (MA) and step therapy for Part B drugs.
- 42 CFR 422.137 · Medicare Advantage Utilization Management Committee.
- 42 CFR 422.138 · Prior authorization.
- 42 CFR 422.152 · Quality improvement program.
- 42 CFR 422.153 · Use of quality improvement organization review information.
- 42 CFR 422.156 · Compliance deemed on the basis of accreditation.
- 42 CFR 422.157 · Accreditation organizations.
- 42 CFR 422.158 · Procedures for approval of accreditation as a basis for deeming compliance.
- 42 CFR 422.160 · Basis and scope of the Medicare Advantage Quality Rating System.
- 42 CFR 422.162 · Medicare Advantage Quality Rating System.
- 42 CFR 422.164 · Adding, updating, and removing measures.
- 42 CFR 422.166 · Calculation of Star Ratings.
- 42 CFR 422.200 · Basis and scope.
- 42 CFR 422.202 · Participation procedures.
- 42 CFR 422.204 · Provider selection and credentialing.
- 42 CFR 422.205 · Provider antidiscrimination rules.
- 42 CFR 422.206 · Interference with health care professionals' advice to enrollees prohibited.
- 42 CFR 422.208 · Physician incentive plans: requirements and limitations.
- 42 CFR 422.210 · Assurances to CMS.
- 42 CFR 422.212 · Limitations on provider indemnification.