e-CFR data is current as of April 15, 2021
TITLE 42—Public Health
CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES 
| Part | Table of
Contents | Headings | |
|---|
SUBCHAPTER A—GENERAL PROVISIONS
|
|
| INTRODUCTION; DEFINITIONS
|
|
|
|
| GENERAL ADMINISTRATIVE REQUIREMENTS
|
|
|
|
| CIVIL MONEY PENALTIES, ASSESSMENTS, AND EXCLUSIONS
|
|
|
|
| SPECIAL PROGRAMS AND PROJECTS
|
|
SUBCHAPTER B—MEDICARE PROGRAM
|
|
| FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
|
|
|
|
| HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT
|
|
|
|
| SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND ENTITLEMENT
|
|
|
|
| PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE
|
|
|
|
| HOSPITAL INSURANCE BENEFITS
|
|
|
|
| SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
|
|
|
|
| EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT
|
|
|
|
| PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES
|
|
|
|
| PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES; PAYMENT FOR ACUTE KIDNEY INJURY DIALYSIS
|
|
|
|
| PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
|
|
|
|
| SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS
|
|
|
|
| AMBULATORY SURGICAL SERVICES
|
|
|
|
| HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS
|
|
|
|
| PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES
|
|
|
|
| PROGRAM INTEGRITY: MEDICARE
|
|
|
|
| MEDICARE ADVANTAGE PROGRAM
|
|
|
|
| VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
|
|
|
|
| CONDITIONS FOR MEDICARE PAYMENT
|
|
|
|
| MEDICARE SHARED SAVINGS PROGRAM
|
|
|
|
| REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS
|
|
SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS
|
|
| GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
|
|
|
|
| STATE ORGANIZATION AND GENERAL ADMINISTRATION
|
|
|
|
| STATE PERSONNEL ADMINISTRATION
|
|
|
|
| STATE FISCAL ADMINISTRATION
|
|
|
|
| ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA
|
|
|
|
| ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS
|
|
|
|
| SERVICES: GENERAL PROVISIONS
|
|
|
|
| SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES
|
|
|
|
| STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES
|
|
|
|
| PROGRAM INTEGRITY: MEDICAID
|
|
SUBCHAPTER D—STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs)
|
|
| ALLOTMENTS AND GRANTS TO STATES
|
|
SUBCHAPTER E—PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
|
|
| PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
|
|
SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS
|
|
| QUALITY IMPROVEMENT ORGANIZATIONS
|
|
|
|
| QUALITY IMPROVEMENT ORGANIZATION REVIEW
|
|
|
|
| RECONSIDERATIONS AND APPEALS
|
|
|
|
| ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION
|
|
SUBCHAPTER G—STANDARDS AND CERTIFICATION
|
|
| CONDITIONS OF PARTICIPATION FOR HOSPITALS
|
|
|
|
| REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES
|
|
|
|
| CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS
|
|
|
|
| CONDITIONS FOR COVERAGE OF SPECIALIZED SERVICES FURNISHED BY SUPPLIERS
|
|
|
|
| SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES
|
|
|
|
| PROVIDER AGREEMENTS AND SUPPLIER APPROVAL
|
|
|
|
| CERTIFICATION OF CERTAIN HEALTH FACILITIES
|
|
|
|
| CONDITIONS FOR COVERAGE FOR END-STAGE RENAL DISEASE FACILITIES
|
|
|
|
| STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM
|
|
|
|
| APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT PARTICIPATION IN THE MEDICARE PROGRAM AND FOR DETERMINATIONS THAT AFFECT THE PARTICIPATION OF ICFs/IID AND CERTAIN NFs IN THE MEDICAID PROGRAM
|
|
SUBCHAPTER H—HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS
|
|
| ESTABLISHMENT OF THE HEALTH CARE INFRASTRUCTURE IMPROVEMENT PROGRAM
|
|
|
|
| COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL
|
|
|
|
| RADIATION ONCOLOGY MODEL AND END STAGE RENAL DISEASE TREATMENT CHOICES MODEL
|
|
|
|
| MOST FAVORED NATION (MFN) MODEL
|
|
SUBCHAPTER I—BASIC HEALTH PROGRAM
|
|
| ADMINISTRATION, ELIGIBILITY, ESSENTIAL HEALTH BENEFITS, PERFORMANCE STANDARDS, SERVICE DELIVERY REQUIREMENTS, PREMIUM AND COST SHARING, ALLOTMENTS, AND RECONCILATION
|
|
|
