About GPO   |   Newsroom/Media   |   Congressional Relations   |   Inspector General   |   Careers   |   Contact   |   askGPO   |   Help  
 
Home   |   Customers   |   Vendors   |   Libraries  

The Electronic Code of Federal Regulations (e-CFR) is a regularly updated, unofficial editorial compilation of CFR material and Federal Register amendments produced by the National Archives and Records Administration's Office of the Federal Register (OFR) and the Government Printing Office.

Parallel Table of Authorities and Rules for the Code of Federal Regulations and the United States Code
Text | PDF

Find, review, and submit comments on Federal rules that are open for comment and published in the Federal Register using Regulations.gov.

Purchase individual CFR titles from the U.S. Government Online Bookstore.

Find issues of the CFR (including issues prior to 1996) at a local Federal depository library.

[1]
 
 

Electronic Code of Federal Regulations

blue pill

e-CFR Data is current as of October 23, 2014

Title 42Chapter IVSubchapter CPart 455


TITLE 42—Public Health

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

SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS

PART 455—PROGRAM INTEGRITY: MEDICAID

rule
§455.1
Basis and scope.
§455.2
Definitions.
§455.3
Other applicable regulations.

Subpart A—MEDICAID AGENCY FRAUD DETECTION AND INVESTIGATION PROGRAM

§455.12
State plan requirement.
§455.13
Methods for identification, investigation, and referral.
§455.14
Preliminary investigation.
§455.15
Full investigation.
§455.16
Resolution of full investigation.
§455.17
Reporting requirements.
§455.18
Provider's statements on claims forms.
§455.19
Provider's statement on check.
§455.20
Beneficiary verification procedure.
§455.21
Cooperation with State Medicaid fraud control units.
§455.23
Suspension of payments in cases of fraud.
rule

Subpart B—DISCLOSURE OF INFORMATION BY PROVIDERS AND FISCAL AGENTS

§455.100
Purpose.
§455.101
Definitions.
§455.102
Determination of ownership or control percentages.
§455.103
State plan requirement.
§455.104
Disclosure by Medicaid providers and fiscal agents: Information on ownership and control.
§455.105
Disclosure by providers: Information related to business transactions.
§455.106
Disclosure by providers: Information on persons convicted of crimes.
rule

Subpart C—MEDICAID INTEGRITY PROGRAM

§455.200
Basis and scope.
§455.202
Limitation on contractor liability.
§455.230
Eligibility requirements.
§455.232
Medicaid integrity audit program contractor functions.
§455.234
Awarding of a contract.
§455.236
Renewal of a contract.
§455.238
Conflict of interest.
§455.240
Conflict of interest resolution.
rule

Subpart D—INDEPENDENT CERTIFIED AUDIT OF STATE DISPROPORTIONATE SHARE HOSPITAL PAYMENT ADJUSTMENTS

§455.300
Purpose.
§455.301
Definitions.
§455.304
Condition for Federal financial participation (FFP).
rule

Subpart E—PROVIDER SCREENING AND ENROLLMENT

§455.400
Purpose.
§455.405
State plan requirements.
§455.410
Enrollment and screening of providers.
§455.412
Verification of provider licenses.
§455.414
Revalidation of enrollment.
§455.416
Termination or denial of enrollment.
§455.420
Reactivation of provider enrollment.
§455.422
Appeal rights.
§455.432
Site visits.
§455.434
Criminal background checks.
§455.436
Federal database checks.
§455.440
National Provider Identifier.
§455.450
Screening levels for Medicaid providers.
§455.452
Other State screening methods.
§455.460
Application fee.
§455.470
Temporary moratoria.
rule

Subpart F—MEDICAID RECOVERY AUDIT CONTRACTORS PROGRAM

§455.500
Purpose.
§455.502
Establishment of program.
§455.504
Definitions.
§455.506
Activities to be conducted by Medicaid RACs and States.
§455.508
Eligibility requirements for Medicaid RACs.
§455.510
Payments to RACs.
§455.512
Medicaid RAC provider appeals.
§455.514
Federal share of State expense of the Medicaid RAC program.
§455.516
Exceptions from Medicaid RAC programs.
§455.518
Applicability to the territories.


For questions or comments regarding e-CFR editorial content, features, or design, email ecfr@nara.gov.
For questions concerning e-CFR programming and delivery issues, email webteam@gpo.gov.