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Electronic Code of Federal Regulations

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e-CFR Data is current as of October 29, 2014

Title 42Chapter IVSubchapter CPart 431


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS

PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION

rule
§431.1
Purpose.

Subpart A—SINGLE STATE AGENCY

§431.10
Single State agency.
§431.11
Organization for administration.
§431.12
Medical care advisory committee.
§431.15
Methods of administration.
§431.16
Reports.
§431.17
Maintenance of records.
§431.18
Availability of agency program manuals.
§431.20
Advance directives.
rule

Subpart B—GENERAL ADMINISTRATIVE REQUIREMENTS

§431.40
Basis and scope.
§431.50
Statewide operation.
§431.51
Free choice of providers.
§431.52
Payments for services furnished out of State.
§431.53
Assurance of transportation.
§431.54
Exceptions to certain State plan requirements.
§431.55
Waiver of other Medicaid requirements.
§431.56
Special waiver provisions applicable to American Samoa and the Northern Mariana Islands.
rule

Subpart C—ADMINISTRATIVE REQUIREMENTS: PROVIDER RELATIONS

§431.105
Consultation to medical facilities.
§431.107
Required provider agreement.
§431.108
Effective date of provider agreements.
§431.110
Participation by Indian Health Service facilities.
§431.115
Disclosure of survey information and provider or contractor evaluation.
§431.120
State requirements with respect to nursing facilities.
rule

Subpart D—APPEALS PROCESS FOR NFS AND ICFS/IID

§431.151
Scope and applicability.
§431.152
State plan requirements.
§431.153
Evidentiary hearing.
§431.154
Informal reconsideration for ICFs/IID.
rule

Subpart E—FAIR HEARINGS FOR APPLICANTS AND BENEFICIARIES

General Provisions

§431.200
Basis and scope.
§431.201
Definitions.
§431.202
State plan requirements.
§431.205
Provision of hearing system.
§431.206
Informing applicants and beneficiaries.

Notice

§431.210
Content of notice.
§431.211
Advance notice.
§431.213
Exceptions from advance notice.
§431.214
Notice in cases of probable fraud.

Right to Hearing

§431.220
When a hearing is required.
§431.221
Request for hearing.
§431.222
Group hearings.
§431.223
Denial or dismissal of request for a hearing.

Procedures

§431.230
Maintaining services.
§431.231
Reinstating services.
§431.232
Adverse decision of local evidentiary hearing.
§431.233
State agency hearing after adverse decision of local evidentiary hearing.
§431.240
Conducting the hearing.
§431.241
Matters to be considered at the hearing.
§431.242
Procedural rights of the applicant or beneficiary.
§431.243
Parties in cases involving an eligibility determination.
§431.244
Hearing decisions.
§431.245
Notifying the applicant or beneficiary of a State agency decision.
§431.246
Corrective action.

Federal Financial Participation

§431.250
Federal financial participation.
rule

Subpart F—SAFEGUARDING INFORMATION ON APPLICANTS AND BENEFICIARIES

§431.300
Basis and purpose.
§431.301
State plan requirements.
§431.302
Purposes directly related to State plan administration.
§431.303
State authority for safeguarding information.
§431.304
Publicizing safeguarding requirements.
§431.305
Types of information to be safeguarded.
§431.306
Release of information.
§431.307
Distribution of information materials.
rule

Subpart G—SECTION 1115 DEMONSTRATIONS

§431.400
Basis and purpose.
§431.404
Definitions.
§431.408
State public notice process.
§431.412
Application procedures.
§431.416
Federal public notice and approval process.
§431.420
Monitoring and compliance.
§431.424
Evaluation requirements.
§431.428
Reporting requirements.
rule

Subparts H-L [Reserved]

rule

Subpart M—RELATIONS WITH OTHER AGENCIES

§431.610
Relations with standard-setting and survey agencies.
§431.615
Relations with State health and vocational rehabilitation agencies and title V grantees.
§431.620
Agreement with State mental health authority or mental institutions.
§431.621
State requirements with respect to nursing facilities.
§431.625
Coordination of Medicaid with Medicare part B.
§431.630
Coordination of Medicaid with QIOs.
§431.635
Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children (WIC).
rule

Subpart N—STATE PROGRAMS FOR LICENSING NURSING HOME ADMINISTRATORS

§431.700
Basis and purpose.
§431.701
Definitions.
§431.702
State plan requirement.
§431.703
Licensing requirement.
§431.704
Nursing homes designated by other terms.
§431.705
Licensing authority.
§431.706
Composition of licensing board.
§431.707
Standards.
§431.708
Procedures for applying standards.
§431.709
Issuance and revocation of license.
§431.710
Provisional licenses.
§431.711
Compliance with standards.
§431.712
Failure to comply with standards.
§431.713
Continuing study and investigation.
§431.714
Waivers.
§431.715
Federal financial participation.
rule

Subpart O—[RESERVED]

rule

Subpart P—QUALITY CONTROL

General Provisions

§431.800
Scope of subpart.
§431.802
Basis.
§431.804
Definitions.
§431.806
State plan requirements.
§431.808
Protection of beneficiary rights.

Medicaid Eligibility Quality Control (MEQC) Program

§431.810
Basic elements of the Medicaid eligibility quality control (MEQC) program.
§431.812
Review procedures.
§431.814
Sampling plan and procedures.
§431.816
Case review completion deadlines and submittal of reports.
§431.818
Access to records: MEQC program.
§431.820
Corrective action under the MEQC program.
§431.822
Resolution of differences in State and Federal case eligibility or payment findings.

Medicaid Quality Control (MQC) Claims Processing Assessment System

§431.830
Basic elements of the Medicaid quality control (MQC) claims processing assessment system.
§431.832
Reporting requirements for claims processing assessment systems.
§431.834
Access to records: Claims processing assessment systems.
§431.836
Corrective action under the MQC claims processing assessment system.

Federal Financial Participation

§§431.861-431.864
[Reserved]
§431.865
Disallowance of Federal financial participation for erroneous State payments (for annual assessment periods ending after July 1, 1990).
rule

Subpart Q—REQUIREMENTS FOR ESTIMATING IMPROPER PAYMENTS IN MEDICAID AND CHIP

§431.950
Purpose.
§431.954
Basis and scope.
§431.958
Definitions and use of terms.
§431.960
Types of payment errors.
§431.970
Information submission requirements.
§431.972
Claims sampling procedures.
§431.974
Basic elements of Medicaid and CHIP eligibility reviews.
§431.978
Eligibility sampling plan and procedures.
§431.980
Eligibility review procedures.
§431.988
Eligibility case review completion deadlines and submittal of reports.
§431.992
Corrective action plan.
§431.998
Difference resolution and appeal process.
§431.1002
Recoveries.


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