42 CFR Part 431
PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION
- PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION
- Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services › Subchapter C—Medical Assistance Programs
- § 431.1 Purpose.
- Subpart A—Single State Agency
- § 431.10 Single State agency.
- § 431.11 Organization for administration.
- § 431.12 Medicaid Advisory Committee and Beneficiary Advisory Council.
- § 431.15 Methods of administration.
- § 431.16 Reports.
- § 431.17 Maintenance of records.
- § 431.18 Availability of agency program manuals.
- § 431.20 Advance directives.
- 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.
- § 431.60 Beneficiary access to and exchange of data.
- § 431.61 Access to and exchange of health data for providers and payers.
- § 431.70 Access to published provider directory information.
- § 431.80 Prior authorization requirements.
- 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.
- 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.
- 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.
- § 431.224 Expedited appeals.
- 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.
- 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.
- 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.
- Subparts H-L [Reserved]
- 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).
- 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.
- Subpart O [Reserved]
- Subpart P—Quality Control
- Medicaid Eligibility Quality Control (MEQC) Program
- § 431.800 Basis and scope.
- § 431.804 Definitions.
- § 431.806 State requirements.
- § 431.808 Protection of beneficiary rights.
- § 431.810 Basic elements of the Medicaid Eligibility Quality Control (MEQC) Program.
- § 431.812 Review procedures.
- § 431.814 Pilot planning document.
- § 431.816 Case review completion deadlines and submittal of reports.
- § 431.818 Access to records.
- § 431.820 Corrective action under the MEQC program.
- 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.
- 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 and systems access requirements.
- § 431.972 Claims sampling procedures.
- § 431.992 Corrective action plan.
- § 431.998 Difference resolution and appeal process.
- § 431.1002 Recoveries.
- § 431.1010 Disallowance of Federal financial participation for erroneous State payments (for PERM review years ending after July 1, 2020).
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