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- 42 CFR 456.351 · Definition.
- 42 CFR 456.360 · Certification and recertification of need for inpatient care.
- 42 CFR 456.370 · Medical, psychological, and social evaluations.
- 42 CFR 456.371 · Exploration of alternative services.
- 42 CFR 456.372 · Medicaid agency review of need for admission.
- 42 CFR 456.380 · Individual written plan of care.
- 42 CFR 456.381 · Reports of evaluations and plans of care.
- 42 CFR 456.400 · Scope.
- 42 CFR 456.401 · State plan UR requirements and options; UR plan required for intermediate care facility services.
- 42 CFR 456.405 · Description of UR review function: How and when.
- 42 CFR 456.406 · Description of UR review function: Who performs UR; disqualification from performing UR.
- 42 CFR 456.407 · UR responsibilities of administrative staff.
- 42 CFR 456.411 · Beneficiary information required for UR.
- 42 CFR 456.412 · Records and reports.
- 42 CFR 456.413 · Confidentiality.
- 42 CFR 456.431 · Continued stay review required.
- 42 CFR 456.432 · Evaluation criteria for continued stay.
- 42 CFR 456.433 · Initial continued stay review date.
- 42 CFR 456.434 · Subsequent continued stay review dates.
- 42 CFR 456.435 · Description of methods and criteria: Continued stay review dates.
- 42 CFR 456.436 · Continued stay review process.
- 42 CFR 456.437 · Notification of adverse decision.
- 42 CFR 456.438 · Time limits for notification of adverse decision.
- 42 CFR 456.480 · Scope.
- 42 CFR 456.481 · Admission certification and plan of care.
- 42 CFR 456.482 · Medical, psychiatric, and social evaluations.
- 42 CFR 456.500 · Purpose.
- 42 CFR 456.501 · UR plans as a condition for FFP.
- 42 CFR 456.505 · Applicability of waiver.
- 42 CFR 456.506 · Waiver options for Medicaid agency.
- 42 CFR 456.507 · Review and granting of waiver requests.
- 42 CFR 456.508 · Withdrawal of waiver.
- 42 CFR 456.520 · Definitions.
- 42 CFR 456.521 · Conditions for granting variance requests.
- 42 CFR 456.522 · Content of request for variance.
- 42 CFR 456.523 · Revised UR plan.
- 42 CFR 456.524 · Notification of Administrator's action and duration of variance.
- 42 CFR 456.525 · Request for renewal of variance.
- 42 CFR 456.600 · Purpose.
- 42 CFR 456.601 · Definitions.
- 42 CFR 456.602 · Inspection team.
- 42 CFR 456.603 · Financial interests and employment of team members.
- 42 CFR 456.604 · Physician team member inspecting care of beneficiaries.
- 42 CFR 456.605 · Number and location of teams.
- 42 CFR 456.606 · Frequency of inspections.
- 42 CFR 456.607 · Notification before inspection.
- 42 CFR 456.608 · Personal contact with and observation of beneficiaries and review of records.
- 42 CFR 456.609 · Determinations by team.
- 42 CFR 456.610 · Basis for determinations.
- 42 CFR 456.611 · Reports on inspections.
- 42 CFR 456.612 · Copies of reports.
- 42 CFR 456.613 · Action on reports.
- 42 CFR 456.614 · Inspections by utilization review committee.
- 42 CFR 456.650 · Basis, purpose and scope.
- 42 CFR 456.651 · Definitions.
- 42 CFR 456.652 · Requirements for an effective utilization control program.
- 42 CFR 456.653 · Acceptable reasons for not meeting requirements for annual on-site review.
- 42 CFR 456.654 · Requirements for content of showings and procedures for submittal.
- 42 CFR 456.655 · Validation of showings.
- 42 CFR 456.656 · Reductions in FFP.
- 42 CFR 456.657 · Computation of reductions in FFP.
- 42 CFR 456.700 · Scope.
- 42 CFR 456.702 · Definitions.
- 42 CFR 456.703 · Drug use review program.
- 42 CFR 456.705 · Prospective drug review.
- 42 CFR 456.709 · Retrospective drug use review.
- 42 CFR 456.711 · Educational program.
- 42 CFR 456.712 · Annual report.
- 42 CFR 456.714 · DUR/surveillance and utilization review relationship.
- 42 CFR 456.716 · DUR Board.
- 42 CFR 456.719 · Funding for DUR program.
- 42 CFR 456.722 · Electronic claims management system.
- 42 CFR 456.725 · Funding of ECM system.
- 42 CFR 457.1 · Program description.
- 42 CFR 457.2 · Basis and scope of subchapter D.
- 42 CFR 457.10 · Definitions and use of terms.
- 42 CFR 457.30 · Basis, scope, and applicability of subpart A.
- 42 CFR 457.40 · State program administration.
- 42 CFR 457.50 · State plan.
- 42 CFR 457.60 · Amendments.
- 42 CFR 457.65 · Effective date and duration of State plans and plan amendments.
- 42 CFR 457.70 · Program options.
- 42 CFR 457.80 · Current State child health insurance coverage and coordination.
- 42 CFR 457.90 · Outreach.
- 42 CFR 457.110 · Enrollment assistance and information requirements.
- 42 CFR 457.120 · Public involvement in program development.
- 42 CFR 457.125 · Provision of child health assistance to American Indian and Alaska Native children.
- 42 CFR 457.130 · Civil rights assurance.
- 42 CFR 457.135 · Assurance of compliance with other provisions.
- 42 CFR 457.140 · Budget.
- 42 CFR 457.150 · CMS review of State plan material.
- 42 CFR 457.160 · Notice and timing of CMS action on State plan material.
- 42 CFR 457.170 · Withdrawal process.
- 42 CFR 457.200 · Program reviews.
- 42 CFR 457.202 · Audits.
- 42 CFR 457.203 · Administrative and judicial review of action on State plan material.
- 42 CFR 457.204 · Withholding of payment for failure to comply with Federal requirements.
- 42 CFR 457.206 · Administrative appeals under CHIP.
- 42 CFR 457.208 · Judicial review.
- 42 CFR 457.216 · Treatment of uncashed or canceled (voided) CHIP checks.