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- 42 CFR 422.214 · Special rules for services furnished by noncontract providers.
- 42 CFR 422.216 · Special rules for MA private fee-for-service plans.
- 42 CFR 422.220 · Exclusion of payment for basic benefits furnished under a private contract.
- 42 CFR 422.222 · Preclusion list for contracted and non-contracted individuals and entities.
- 42 CFR 422.224 · Payment to individuals and entities excluded by the OIG or included on the preclusion list.
- 42 CFR 422.250 · Basis and scope.
- 42 CFR 422.252 · Terminology.
- 42 CFR 422.254 · Submission of bids.
- 42 CFR 422.256 · Review, negotiation, and approval of bids.
- 42 CFR 422.258 · Calculation of benchmarks.
- 42 CFR 422.260 · Appeals of quality bonus payment determinations.
- 42 CFR 422.262 · Beneficiary premiums.
- 42 CFR 422.264 · Calculation of savings.
- 42 CFR 422.266 · Beneficiary rebates.
- 42 CFR 422.270 · Incorrect collections of premiums and cost-sharing.
- 42 CFR 422.272 · Release of MA bid pricing data.
- 42 CFR 422.300 · Basis and scope.
- 42 CFR 422.304 · Monthly payments.
- 42 CFR 422.306 · Annual MA capitation rates.
- 42 CFR 422.308 · Adjustments to capitation rates, benchmarks, bids, and payments.
- 42 CFR 422.310 · Risk adjustment data.
- 42 CFR 422.311 · RADV audit dispute and appeal processes.
- 42 CFR 422.312 · Announcement of annual capitation rate, benchmarks, and methodology changes.
- 42 CFR 422.314 · Special rules for beneficiaries enrolled in MA MSA plans.
- 42 CFR 422.316 · Special rules for payments to Federally qualified health centers.
- 42 CFR 422.318 · Special rules for coverage that begins or ends during an inpatient hospital stay.
- 42 CFR 422.320 · Special rules for hospice care.
- 42 CFR 422.322 · Source of payment and effect of MA plan election on payment.
- 42 CFR 422.324 · Payments to MA organizations for graduate medical education costs.
- 42 CFR 422.326 · Reporting and returning of overpayments.
- 42 CFR 422.330 · CMS-identified overpayments associated with payment data submitted by MA organizations.
- 42 CFR 422.350 · Basis, scope, and definitions.
- 42 CFR 422.352 · Basic requirements.
- 42 CFR 422.354 · Requirements for affiliated providers.
- 42 CFR 422.356 · Determining substantial financial risk and majority financial interest.
- 42 CFR 422.370 · Waiver of State licensure.
- 42 CFR 422.372 · Basis for waiver of State licensure.
- 42 CFR 422.374 · Waiver request and approval process.
- 42 CFR 422.376 · Conditions of the waiver.
- 42 CFR 422.378 · Relationship to State law.
- 42 CFR 422.380 · Solvency standards.
- 42 CFR 422.382 · Minimum net worth amount.
- 42 CFR 422.384 · Financial plan requirement.
- 42 CFR 422.386 · Liquidity.
- 42 CFR 422.388 · Deposits.
- 42 CFR 422.390 · Guarantees.
- 42 CFR 422.400 · State licensure requirement.
- 42 CFR 422.402 · Federal preemption of State law.
- 42 CFR 422.404 · State premium taxes prohibited.
- 42 CFR 422.451 · Moratorium on new local preferred provider organization plans.
- 42 CFR 422.455 · Special rules for MA Regional Plans.
- 42 CFR 422.458 · Risk sharing with regional MA organizations for 2006 and 2007.
- 42 CFR 422.500 · Scope and definitions.
- 42 CFR 422.501 · Application requirements.
- 42 CFR 422.502 · Evaluation and determination procedures.
- 42 CFR 422.503 · General provisions.
- 42 CFR 422.504 · Contract provisions.
- 42 CFR 422.505 · Effective date and term of contract.
- 42 CFR 422.506 · Nonrenewal of contract.
- 42 CFR 422.508 · Modification or termination of contract by mutual consent.
- 42 CFR 422.510 · Termination of contract by CMS.
- 42 CFR 422.512 · Termination of contract by the MA organization.
- 42 CFR 422.514 · Enrollment requirements.
- 42 CFR 422.516 · Validation of Part C reporting requirements.
- 42 CFR 422.520 · Prompt payment by MA organization.
- 42 CFR 422.521 · Effective date of new significant regulatory requirements.
- 42 CFR 422.524 · Special rules for RFB societies.
- 42 CFR 422.527 · Agreements with Federally qualified health centers.
- 42 CFR 422.528 · Final settlement process and payment.
- 42 CFR 422.529 · Requesting an appeal of the final settlement amount.
- 42 CFR 422.530 · Plan crosswalks.
- 42 CFR 422.550 · General provisions.
- 42 CFR 422.552 · Novation agreement requirements.
- 42 CFR 422.553 · Effect of leasing of an MA organization's facilities.
- 42 CFR 422.560 · Basis and scope.
- 42 CFR 422.561 · Definitions.
- 42 CFR 422.562 · General provisions.
- 42 CFR 422.564 · Grievance procedures.
- 42 CFR 422.566 · Organization determinations.
- 42 CFR 422.568 · Standard timeframes and notice requirements for organization determinations.
- 42 CFR 422.570 · Expediting certain organization determinations.
- 42 CFR 422.572 · Timeframes and notice requirements for expedited organization determinations.
- 42 CFR 422.574 · Parties to the organization determination.
- 42 CFR 422.576 · Effect of an organization determination.
- 42 CFR 422.578 · Right to a reconsideration.
- 42 CFR 422.580 · Reconsideration defined.
- 42 CFR 422.582 · Request for a standard reconsideration.
- 42 CFR 422.584 · Expediting certain reconsiderations.
- 42 CFR 422.586 · Opportunity to submit evidence.
- 42 CFR 422.590 · Timeframes and responsibility for reconsiderations.
- 42 CFR 422.592 · Reconsideration by an independent entity.
- 42 CFR 422.594 · Notice of reconsidered determination by the independent entity.
- 42 CFR 422.596 · Effect of a reconsidered determination.
- 42 CFR 422.600 · Right to a hearing.
- 42 CFR 422.602 · Request for an ALJ hearing.
- 42 CFR 422.608 · Medicare Appeals Council (Council) review.
- 42 CFR 422.612 · Judicial review.
- 42 CFR 422.616 · Reopening and revising determinations and decisions.
- 42 CFR 422.618 · How an MA organization must effectuate standard reconsidered determinations or decisions.
- 42 CFR 422.619 · How an MA organization must effectuate expedited reconsidered determinations.