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- 42 CFR 460.150 · Eligibility to enroll in a PACE program.
- 42 CFR 460.152 · Enrollment process.
- 42 CFR 460.154 · Enrollment agreement.
- 42 CFR 460.156 · Other enrollment procedures.
- 42 CFR 460.158 · Effective date of enrollment.
- 42 CFR 460.160 · Continuation of enrollment.
- 42 CFR 460.162 · Voluntary disenrollment.
- 42 CFR 460.164 · Involuntary disenrollment.
- 42 CFR 460.166 · Disenrollment responsibilities.
- 42 CFR 460.168 · Reinstatement in other Medicare and Medicaid programs.
- 42 CFR 460.170 · Reinstatement in PACE.
- 42 CFR 460.172 · Documentation of disenrollment.
- 42 CFR 460.180 · Medicare payment to PACE organizations.
- 42 CFR 460.182 · Medicaid payment.
- 42 CFR 460.184 · Post-eligibility treatment of income.
- 42 CFR 460.186 · PACE premiums.
- 42 CFR 460.190 · Monitoring during trial period.
- 42 CFR 460.192 · Ongoing monitoring after trial period.
- 42 CFR 460.194 · Corrective action.
- 42 CFR 460.196 · Disclosure of review results.
- 42 CFR 460.198 · Disclosure of compliance deficiencies.
- 42 CFR 460.200 · Maintenance of records and reporting of data.
- 42 CFR 460.202 · Participant health outcomes data.
- 42 CFR 460.204 · Financial recordkeeping and reporting requirements.
- 42 CFR 460.208 · Financial statements.
- 42 CFR 460.210 · Medical records.
- 42 CFR 475.1 · Definitions.
- 42 CFR 475.100 · Scope and applicability.
- 42 CFR 475.101 · Eligibility requirements for QIO contracts.
- 42 CFR 475.102 · Requirements for performing case reviews.
- 42 CFR 475.103 · Requirements for performing quality improvement initiatives.
- 42 CFR 475.104 · [Reserved]
- 42 CFR 475.105 · Prohibition against contracting with health care facilities, affiliates, and payor organizations.
- 42 CFR 475.106 · [Reserved]
- 42 CFR 475.107 · QIO contract awards.
- 42 CFR 476.1 · Definitions.
- 42 CFR 476.70 · Statutory bases and applicability.
- 42 CFR 476.71 · QIO review requirements.
- 42 CFR 476.73 · Notification of QIO designation and implementation of review.
- 42 CFR 476.74 · General requirements for the assumption of review.
- 42 CFR 476.76 · Cooperation with health care facilities.
- 42 CFR 476.78 · Responsibilities of providers and practitioners.
- 42 CFR 476.80 · Coordination with Medicare administrative contractors, fiscal intermediaries, and carriers
- 42 CFR 476.82 · Continuation of functions not assumed by QIOs.
- 42 CFR 476.83 · Initial denial determinations.
- 42 CFR 476.84 · Changes as a result of DRG validation.
- 42 CFR 476.85 · Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
- 42 CFR 476.86 · Correlation of Title XI functions with Title XVIII functions.
- 42 CFR 476.88 · Examination of the operations and records of health care facilities and practitioners.
- 42 CFR 476.90 · Lack of cooperation by a provider or practitioner.
- 42 CFR 476.93 · Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.
- 42 CFR 476.94 · Notice of QIO initial denial determination and changes as a result of a DRG validation.
- 42 CFR 476.96 · Review period and reopening of initial denial determinations and changes as a result of DRG validations.
- 42 CFR 476.98 · Reviewer qualifications and participation.
- 42 CFR 476.100 · Use of norms and criteria.
- 42 CFR 476.102 · Involvement of health care practitioners other than physicians.
- 42 CFR 476.104 · Coordination of activities.
- 42 CFR 476.110 · Use of immediate advocacy to resolve oral beneficiary complaints.
- 42 CFR 476.120 · Submission of written beneficiary complaints.
- 42 CFR 476.130 · Beneficiary complaint review procedures.
- 42 CFR 476.140 · Beneficiary complaint reconsideration procedures.
- 42 CFR 476.150 · Abandoned complaints and reopening rights.
- 42 CFR 476.160 · General quality of care review procedures.
- 42 CFR 476.170 · General quality of care reconsideration procedures.
- 42 CFR 478.10 · Scope.
- 42 CFR 478.12 · Statutory basis.
- 42 CFR 478.14 · Applicability.
- 42 CFR 478.15 · QIO review of changes resulting from DRG validation.
- 42 CFR 478.16 · Right to reconsideration.
- 42 CFR 478.18 · Location for submitting requests for reconsideration.
- 42 CFR 478.20 · Time limits for requesting reconsideration.
- 42 CFR 478.22 · Good cause for late filing of a request for a reconsideration or hearing.
- 42 CFR 478.24 · Opportunity for a party to obtain and submit information.
- 42 CFR 478.26 · Delegation of the reconsideration function.
- 42 CFR 478.28 · Qualifications of a reconsideration reviewer.
- 42 CFR 478.30 · Evidence to be considered by the reconsideration reviewer.
- 42 CFR 478.32 · Time limits for issuance of the reconsidered determination.
- 42 CFR 478.34 · Notice of a reconsidered determination.
- 42 CFR 478.36 · Record of reconsideration.
- 42 CFR 478.38 · Effect of a reconsidered determination.
- 42 CFR 478.40 · Beneficiary's right to a hearing.
- 42 CFR 478.42 · Submitting a request for a hearing.
- 42 CFR 478.44 · Determining the amount in controversy for a hearing.
- 42 CFR 478.46 · Medicare Appeals Council and judicial review.
- 42 CFR 478.48 · Reopening and revision of a reconsidered determination or a decision.
- 42 CFR 480.101 · Scope and definitions.
- 42 CFR 480.102 · Statutory bases for acquisition and maintenance of information.
- 42 CFR 480.103 · Statutory bases for disclosure of information.
- 42 CFR 480.104 · Procedures for disclosure by a QIO.
- 42 CFR 480.105 · Notice of disclosures made by a QIO.
- 42 CFR 480.106 · Exceptions to QIO notice requirements.
- 42 CFR 480.107 · Limitations on redisclosure.
- 42 CFR 480.108 · Penalties for unauthorized disclosure.
- 42 CFR 480.109 · Applicability of other statutes and regulations.
- 42 CFR 480.111 · QIO access to records and information of institutions and practitioners.
- 42 CFR 480.112 · QIO access to records and information of intermediaries and carriers.
- 42 CFR 480.113 · QIO access to information collected for QIO purposes.
- 42 CFR 480.114 · Limitation on data collection.
- 42 CFR 480.115 · Requirements for maintaining confidentiality.
- 42 CFR 480.116 · Notice to individuals and institutions under review.