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- 42 CFR 438.116 · Solvency standards.
- 42 CFR 438.206 · Availability of services.
- 42 CFR 438.207 · Assurances of adequate capacity and services.
- 42 CFR 438.208 · Coordination and continuity of care.
- 42 CFR 438.210 · Coverage and authorization of services.
- 42 CFR 438.214 · Provider selection.
- 42 CFR 438.224 · Confidentiality.
- 42 CFR 438.228 · Grievance and appeal systems.
- 42 CFR 438.230 · Subcontractual relationships and delegation.
- 42 CFR 438.236 · Practice guidelines.
- 42 CFR 438.242 · Health information systems.
- 42 CFR 438.310 · Basis, scope, and applicability.
- 42 CFR 438.320 · Definitions.
- 42 CFR 438.330 · Quality assessment and performance improvement program.
- 42 CFR 438.332 · State review of the accreditation status of MCOs, PIHPs, and PAHPs.
- 42 CFR 438.334 · [Reserved]
- 42 CFR 438.340 · Managed care State quality strategy.
- 42 CFR 438.350 · External quality review.
- 42 CFR 438.352 · External quality review protocols.
- 42 CFR 438.354 · Qualifications of external quality review organizations.
- 42 CFR 438.356 · State contract options for external quality review.
- 42 CFR 438.358 · Activities related to external quality review.
- 42 CFR 438.360 · Nonduplication of mandatory activities with Medicare or accreditation review.
- 42 CFR 438.362 · Exemption from external quality review.
- 42 CFR 438.364 · External quality review results.
- 42 CFR 438.370 · Federal financial participation (FFP).
- 42 CFR 438.400 · Statutory basis, definitions, and applicability.
- 42 CFR 438.402 · General requirements.
- 42 CFR 438.404 · Timely and adequate notice of adverse benefit determination.
- 42 CFR 438.406 · Handling of grievances and appeals.
- 42 CFR 438.408 · Resolution and notification: Grievances and appeals.
- 42 CFR 438.410 · Expedited resolution of appeals.
- 42 CFR 438.414 · Information about the grievance and appeal system to providers and subcontractors.
- 42 CFR 438.416 · Recordkeeping requirements.
- 42 CFR 438.420 · Continuation of benefits while the MCO, PIHP, or PAHP appeal and the State fair hearing are pending.
- 42 CFR 438.424 · Effectuation of reversed appeal resolutions.
- 42 CFR 438.500 · Definitions.
- 42 CFR 438.505 · General rule and applicability.
- 42 CFR 438.510 · Mandatory QRS measure set for Medicaid managed care quality rating system.
- 42 CFR 438.515 · Medicaid managed care quality rating system methodology.
- 42 CFR 438.520 · website display.
- 42 CFR 438.525 · [Reserved]
- 42 CFR 438.530 · Annual technical resource manual.
- 42 CFR 438.535 · Annual reporting.
- 42 CFR 438.600 · Statutory basis, basic rule, and applicability.
- 42 CFR 438.602 · State responsibilities.
- 42 CFR 438.604 · Data, information, and documentation that must be submitted.
- 42 CFR 438.606 · Source, content, and timing of certification.
- 42 CFR 438.608 · Program integrity requirements under the contract.
- 42 CFR 438.610 · Prohibited affiliations.
- 42 CFR 438.700 · Basis for imposition of sanctions.
- 42 CFR 438.702 · Types of intermediate sanctions.
- 42 CFR 438.704 · Amounts of civil money penalties.
- 42 CFR 438.706 · Special rules for temporary management.
- 42 CFR 438.708 · Termination of an MCO, PCCM or PCCM entity contract.
- 42 CFR 438.710 · Notice of sanction and pre-termination hearing.
- 42 CFR 438.722 · Disenrollment during termination hearing process.
- 42 CFR 438.724 · Notice to CMS.
- 42 CFR 438.726 · State plan requirement.
- 42 CFR 438.730 · Sanction by CMS: Special rules for MCOs.
- 42 CFR 438.802 · Basic requirements.
- 42 CFR 438.806 · Prior approval.
- 42 CFR 438.808 · Exclusion of entities.
- 42 CFR 438.810 · Expenditures for enrollment broker services.
- 42 CFR 438.812 · Costs under risk and nonrisk contracts.
- 42 CFR 438.816 · Expenditures for the beneficiary support system for enrollees using LTSS.
- 42 CFR 438.818 · Enrollee encounter data.
- 42 CFR 438.900 · Meaning of terms.
- 42 CFR 438.905 · Parity requirements for aggregate lifetime and annual dollar limits.
- 42 CFR 438.910 · Parity requirements for financial requirements and treatment limitations.
- 42 CFR 438.915 · Availability of information.
- 42 CFR 438.920 · Applicability.
- 42 CFR 438.930 · Compliance dates.
- 42 CFR 440.1 · Basis and purpose.
- 42 CFR 440.2 · Specific definitions; definitions of services for FFP purposes.
- 42 CFR 440.10 · Inpatient hospital services, other than services in an institution for mental diseases.
- 42 CFR 440.20 · Outpatient hospital services and rural health clinic services.
- 42 CFR 440.30 · Other laboratory and X-ray services.
- 42 CFR 440.40 · Nursing facility services for individuals age 21 or older (other than services in an institution for mental disease), EPSDT, and family planning services and supplies.
- 42 CFR 440.50 · Physicians' services and medical and surgical services of a dentist.
- 42 CFR 440.60 · Medical or other remedial care provided by licensed practitioners.
- 42 CFR 440.70 · Home health services.
- 42 CFR 440.80 · Private duty nursing services.
- 42 CFR 440.90 · Clinic services.
- 42 CFR 440.100 · Dental services.
- 42 CFR 440.110 · Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders.
- 42 CFR 440.120 · Prescribed drugs, dentures, prosthetic devices, and eyeglasses.
- 42 CFR 440.130 · Diagnostic, screening, preventive, and rehabilitative services.
- 42 CFR 440.140 · Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals age 65 or older in institutions for mental diseases.
- 42 CFR 440.150 · Intermediate care facility (ICF/IID) services.
- 42 CFR 440.155 · Nursing facility services, other than in institutions for mental diseases.
- 42 CFR 440.160 · Inpatient psychiatric services for individuals under age 21.
- 42 CFR 440.165 · Nurse-midwife service.
- 42 CFR 440.166 · Nurse practitioner services.
- 42 CFR 440.167 · Personal care services.
- 42 CFR 440.168 · Primary care case management services.
- 42 CFR 440.169 · Case management services.
- 42 CFR 440.170 · Any other medical care or remedial care recognized under State law and specified by the Secretary.
- 42 CFR 440.180 · Home and community-based waiver services.
- 42 CFR 440.181 · Home and community-based services for individuals age 65 or older.