{"data":{"id":"us/42-cfr-456.650","jurisdiction":"us","citation":"42 CFR 456.650","heading":"Basis, purpose and scope.","body":"(a) Basis. Section 1903(g) of the Act requires that FFP for long-stay inpatient services at a level of care be reduced, by a specified formula, for any quarter in which a State fails to make a satisfactory showing that it has an effective program of utilization control for that level of care.\n(b) Purpose. This subpart specifies—\n(1) What States must do to make a satisfactory showing;\n(2) How the Administrator will determine whether reductions will be imposed; and\n(3) How the required reductions will be implemented.\n(c) Scope. The reductions required by this subpart do not apply to—\n(1) Services provided under a contract with a health maintenance organization; or\n(2) Facilities in which a QIO is performing medical and utilization reviews under contract with the Medicaid agency in accordance with § 431.630 of this chapter.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS","PART 456—UTILIZATION CONTROL","Subpart J—Penalty for Failure To Make a Satisfactory Showing of an Effective Institutional Utilization Control Program"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"bd6681fd8268e92cf7dd4f0e5df23aec9c7e4445b1c3094f7036531343f14940","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-456.614","next":"us/42-cfr-456.651"},"notice":"GroundRules: Original legal text. Not legal advice."}