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e-CFR Data is current as of February 4, 2010
TITLE 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER C--MEDICAL ASSISTANCE PROGRAMS
PART 431--STATE ORGANIZATION AND GENERAL ADMINISTRATION
Subpart A--SINGLE STATE AGENCY
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| Organization for administration. |
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| Medical care advisory committee. |
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| Methods of administration. |
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| Availability of agency program manuals. |
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Subpart B--GENERAL ADMINISTRATIVE REQUIREMENTS
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| Free choice of providers. |
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| Payments for services furnished out of State. |
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| Assurance of transportation. |
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| Exceptions to certain State plan requirements. |
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| Waiver of other Medicaid requirements. |
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| Special waiver provisions applicable to American Samoa and the Northern Mariana Islands. |
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| Waiver of cost-sharing requirements. |
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Subpart C--ADMINISTRATIVE REQUIREMENTS: PROVIDER RELATIONS
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| Consultation to medical facilities. |
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| Required provider agreement. |
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| Effective date of provider agreements. |
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| Participation by Indian Health Service facilities. |
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| Disclosure of survey information and provider or contractor evaluation. |
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| State requirements with respect to nursing facilities. |
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Subpart D--APPEALS PROCESS FOR NFS AND ICFS/MR
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| Informal reconsideration for ICFs/MR. |
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Subpart E--FAIR HEARINGS FOR APPLICANTS AND RECIPIENTS
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| Provision of hearing system. |
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| Informing applicants and recipients. |
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| Exceptions from advance notice. |
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| Notice in cases of probable fraud. |
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| When a hearing is required. |
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| Denial or dismissal of request for a hearing. |
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| Reinstatement of services. |
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| Adverse decision of local evidentiary hearing. |
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| State agency hearing after adverse decision of local evidentiary hearing. |
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| Matters to be considered at the hearing. |
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| Procedural rights of the applicant or recipient. |
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| Parties in cases involving an eligibility determination. |
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| Notifying the applicant or recipient of a State agency decision. |
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| Federal financial participation. |
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Subpart F--SAFEGUARDING INFORMATION ON APPLICANTS AND RECIPIENTS
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| Purposes directly related to State plan administration. |
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| State authority for safeguarding information. |
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| Publicizing safeguarding requirements. |
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| Types of information to be safeguarded. |
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| Distribution of information materials. |
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Subparts G-L--[RESERVED]
Subpart M--RELATIONS WITH OTHER AGENCIES
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| Relations with standard-setting and survey agencies. |
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| Relations with State health and vocational rehabilitation agencies and title V grantees. |
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| Agreement with State mental health authority or mental institutions. |
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| State requirements with respect to nursing facilities. |
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| Coordination of Medicaid with Medicare part B. |
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| Coordination of Medicaid with QIOs. |
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| Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children (WIC). |
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| Coordination of Medicaid with the State Children's Health Insurance Program (SCHIP). |
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Subpart N--STATE PROGRAMS FOR LICENSING NURSING HOME ADMINISTRATORS
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| Nursing homes designated by other terms. |
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| Composition of licensing board. |
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| Procedures for applying standards. |
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| Issuance and revocation of license. |
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| Compliance with standards. |
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| Failure to comply with standards. |
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| Continuing study and investigation. |
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| Federal financial participation. |
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Subpart O--[RESERVED]
Subpart P--QUALITY CONTROL
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| Protection of recipient rights. |
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| Basic elements of the Medicaid eligibility quality control (MEQC) program. |
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| Sampling plan and procedures. |
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| Case review completion deadlines and submittal of reports. |
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| Access to records: MEQC program. |
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| Corrective action under the MEQC program. |
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| Resolution of differences in State and Federal case eligibility or payment findings. |
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| Basic elements of the Medicaid quality control (MQC) claims processing assessment system. |
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| Reporting requirements for claims processing assessment systems. |
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| Access to records: Claims processing assessment systems. |
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| Corrective action under the MQC claims processing assessment system. |
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| Disallowance of Federal financial participation for erroneous State payments (for annual assessment periods ending after July 1, 1990). |
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Subpart Q--REQUIREMENTS FOR ESTIMATING IMPROPER PAYMENTS IN MEDICAID AND SCHIP
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| Definitions and use of terms. |
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| Information submission requirements. |
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| Basic elements of Medicaid and SCHIP eligibility reviews. |
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| Eligibility sampling plan and procedures. |
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| Eligibility review procedures. |
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| Eligibility case review completion deadlines and submittal of reports. |
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| Difference resolution process. |
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