e-CFR data is current as of January 16, 2020
TITLE 42—Public Health
CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBCHAPTER A—GENERAL PROVISIONS PART 403—SPECIAL PROGRAMS AND PROJECTS
Subpart A—[RESERVED]
Subpart B—MEDICARE SUPPLEMENTAL POLICIES
General Provisions
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| State regulation of insurance policies. |
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| Medicare supplemental policy. |
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| General standards for Medicare supplemental policies. |
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State Regulatory Programs
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| Supplemental Health Insurance Panel. |
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| State with an approved regulatory program. |
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Voluntary Certification Program: General Provisions
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| Requirements and procedures for obtaining certification. |
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| Review and certification of policies. |
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| Submittal of material to retain certification. |
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| Administrative review of CMS determinations. |
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Voluntary Certification Program: Loss Ratio Provisions
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| Loss ratio calculations: General provisions. |
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| Loss ratio date and time frame provisions. |
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| Loss ratio supporting data. |
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| Statement of actuarial opinion. |
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Subpart C—RECOGNITION OF STATE REIMBURSEMENT CONTROL SYSTEMS
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| Minimum requirements for State systems—discretionary approval. |
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| Additional requirements for State systems—mandatory approval. |
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| State systems under demonstration projects—mandatory approval. |
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| Submittal of application. |
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| Evaluation of State systems. |
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| Reconsideration of certain denied applications. |
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| Approval of State systems. |
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| CMS review and monitoring of State systems. |
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| State systems for hospital outpatient services. |
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| Termination of agreements for Medicare recognition of State systems. |
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Subparts D—F [Reserved]
Subpart G—RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS—BENEFITS, CONDITIONS OF PARTICIPATION, AND PAYMENT
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| Valid election requirements. |
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| Condition of participation: Patient rights. |
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| Condition of participation: Quality assessment and performance improvement. |
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| Condition of participation: Food services. |
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| Condition of participation: Discharge planning. |
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| Condition of participation: Administration. |
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| Condition of participation: Staffing. |
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| Condition of participation: Physical environment. |
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| Condition of participation: Life safety from fire. |
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| Condition of participation: Building safety. |
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| Condition of participation: Utilization review. |
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| Condition of participation: Emergency preparedness. |
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| Estimate of expenditures and adjustments. |
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| Monitoring expenditure level. |
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| Basis and purpose of religious nonmedical health care institutions providing home service. |
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| Requirements for coverage and payment of RNHCI home services. |
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| Payments for home services. |
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Subpart H—MEDICARE PRESCRIPTION DRUG DISCOUNT CARD AND TRANSITIONAL ASSISTANCE PROGRAM
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| General rules for solicitation, application and Medicare endorsement period. |
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| Sponsor requirements for eligibility for endorsement. |
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| Use of transitional assistance funds. |
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| Eligibility and reconsiderations. |
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| Enrollment and disenrollment and associated endorsed sponsor requirements. |
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| HIPAA privacy, security, administrative data standards, and national identifiers. |
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| Marketing limitations and record retention requirements. |
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| Special rules concerning Part C organizations and Medicare cost plans and their enrollees. |
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| Special rules concerning States. |
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| Special rules concerning long-term care and I/T/U pharmacies. |
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| Special rules concerning the territories. |
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| Sanctions, penalties, and termination. |
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| Reimbursement of transitional assistance and associated sponsor requirements. |
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Subpart I—TRANSPARENCY REPORTS AND REPORTING OF PHYSICIAN OWNERSHIP OR INVESTMENT INTERESTS
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| Reports of payments or other transfers of value to covered recipients. |
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| Reports of physician ownership and investment interests. |
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| Procedures for electronic submission of reports. |
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| Delayed publication for payments made under product research or development agreements and clinical investigations. |
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| Penalties for failure to report. |
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| Preemption of State laws. |
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Subpart K—ACCESS TO IDENTIFIABLE DATA FOR THE CENTER FOR MEDICARE AND MEDICAID MODELS
Subpart L—REQUIREMENTS FOR DIRECT-TO-CONSUMER TELEVISION ADVERTISEMENTS OF DRUGS AND BIOLOGICAL PRODUCTS TO INCLUDE THE LIST PRICE OF THAT ADVERTISED PRODUCT
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| Specific presentation requirements. |
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