• Title 42 -- Public Health
• CHAPTER IV -- CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Part

• 400 Introduction; definitions
• 401 General administrative requirements
• 402 Civil money penalties, assessments, and exclusions
• 403 Special programs and projects
• 405 Federal health insurance for the aged and disabled
• 406 Hospital insurance eligibility and entitlement
• 407 Supplementary medical insurance (SMI) enrollment and entitlement
• 408 Premiums for supplementary medical insurance
• 409 Hospital insurance benefits
• 410 Supplementary medical insurance (SMI) benefits
• 411 Exclusions from Medicare and limitations on Medicare payment
• 412 Prospective payment systems for inpatient hospital services
• 413 Principles of reasonable cost reimbursement; payment for end-stage renal disease services; prospectively determined payment rates for skilled nursing facilities
• 414 Payment for Part B medical and other health services
• 415 Services furnished by physicians in providers, supervising physicians in teaching settings, and residents in certain settings
• 416 Ambulatory surgical services
• 417 Health maintenance organizations, competitive medical plans, and health care prepayment plans
• 418 Hospice care
• 419 Prospective payment system for hospital outpatient department services
• 420 Program integrity: Medicare
• 421 Medicare contracting
• 422 Medicare advantage program
• 423 Voluntary medicare prescription drug benefit
• 424 Conditions for Medicare payment
• 426 Review of national coverage determinations and local coverage determinations
• 430 Grants to States for Medical Assistance Programs
• 431 State organization and general administration.
• 432 State personnel administration
• 433 State fiscal administration
• 434 Contracts
• 435 Eligibility in the States, District of Columbia, the Northern Mariana Islands, and American Samoa
• 436 Eligibility in Guam, Puerto Rico, and the Virgin Islands
• 438 Managed care
• 440 Services: General provisions.
• 441 Services: Requirements and limits applicable to specific services
• 442 Standards for payment to nursing facilities and intermediate care facilities for the mentally retarded
• 447 Payments for services
• 455 Program integrity: Medicaid
• 456 Utilization control
• 457 Allotments and grants to States
• 460 Programs of all-inclusive care for the elderly (PACE)
• 475 Quality improvement organizations
• 476 Utilization and quality control review
• 478 Reconsiderations and appeals
• 480 Acquisition, protection, and disclosure of quality improvement organization information
• 482 Conditions of participation for hospitals
• 483 Requirements for States and long term care facilities
• 484 Home health services
• 485 Conditions of participation: Specialized providers
• 486 Conditions for coverage of specialized services furnished by suppliers
• 488 Survey, certification, and enforcement procedures
• 489 Provider agreements and supplier approval
• 491 Certification of certain health facilities
• 493 Laboratory requirements
• 498 Appeals procedures for determinations that affect participation in the Medicare program and for determinations that affect the participation of ICFs/MR and certain NFs in the Medicaid program
• 505 Establishment of the health care infrastructure improvement program
• 403.201 State regulation of insurance policies. [PDF]
• 403.206 General standards for Medicare supplemental policies. [PDF]
• 403.215 Loss ratio standards. [PDF]
• 403.220 Supplemental Health Insurance Panel. [PDF]
• 403.222 State with an approved regulatory program. [PDF]
• 403.231 Emblem. [PDF]
• 403.232 Requirements and procedures for obtaining certification. [PDF]
• 403.239 Submittal of material to retain certification. [PDF]
• 403.245 Loss of certification. [PDF]
• 403.250 Loss ratio calculations: General provisions. [PDF]
• 403.251 Loss ratio date and time frame provisions. [PDF]
• 403.253 Calculation of benefits. [PDF]
• 403.254 Calculation of premiums. [PDF]
• 403.256 Loss ratio supporting data. [PDF]
• 403.258 Statement of actuarial opinion. [PDF]
• 403.300 Basis and purpose. [PDF]
• 403.302 Definitions. [PDF]
• 403.304 Minimum requirements for State systems--discretionary approval. [PDF]
• 403.306 Additional requirements for State systems--mandatory approval. [PDF]
• 403.308 State systems under demonstration projects--mandatory approval. [PDF]
• 403.310 Reduction in payments. [PDF]
• 403.312 Submittal of application. [PDF]
• 403.316 Reconsideration of certain denied applications. [PDF]
• 403.318 Approval of State systems. [PDF]
• 403.320 CMS review and monitoring of State systems. [PDF]
• 403.321 State systems for hospital outpatient services. [PDF]
• 403.500 Basis, scope, and definition. [PDF]
• 403.501 Eligibility for grants. [PDF]
• 403.502 Availability of grants. [PDF]
• 403.504 Number and size of grants. [PDF]
• 403.508 Limitations. [PDF]
• 403.510 Reporting requirements. [PDF]
• 403.512 Administration. [PDF]
• 403.700 Basis and purpose. [PDF]
• 403.702 Definitions and terms. [PDF]
• 403.720 Conditions for coverage. [PDF]
• 403.724 Valid election requirements. [PDF]
• 403.730 Condition of participation: Patient rights. [PDF]
• 403.732 Condition of participation: Quality assessment and performance improvement. [PDF]
• 403.734 Condition of participation: Food services. [PDF]
• 403.738 Condition of participation: Administration. [PDF]
• 403.740 Condition of participation: Staffing. [PDF]
• 403.744 Condition of participation: Life safety from fire. [PDF]
• 403.746 Condition of participation: Utilization review. [PDF]
• 403.750 Estimate of expenditures and adjustments. [PDF]
• 403.752 Payment provisions. [PDF]
• 403.754 Monitoring expenditure level. [PDF]
• 403.756 Sunset provision. [PDF]
• 403.764 Basis and purpose of religious nonmedical health care institutions providing home service. [PDF]
• 403.768 Excluded services. [PDF]
• 403.800 Basis and scope. [PDF]
• 403.802 Definitions. [PDF]
• 403.804 General rules for solicitation, application and Medicare endorsement period. [PDF]
• 403.806 Sponsor requirements for eligibility for endorsement. [PDF]
• 403.810 Eligibility and reconsiderations. [PDF]
• 403.811 Enrollment and disenrollment and associated endorsed sponsor requirements. [PDF]
• 403.812 HIPAA privacy, security, administrative data standards, and national identifiers. [PDF]
• 403.813 Marketing limitations and record retention requirements. [PDF]
• 403.814 Special rules concerning Part C organizations and Medicare cost plans and their enrollees. [PDF]
• 403.815 Special rules concerning States. [PDF]
• 403.816 Special rules concerning long-term care and I/T/U pharmacies. [PDF]
• 403.817 Special rules concerning the territories. [PDF]
• 403.820 Sanctions, penalties, and termination. [PDF]
• 403.822 Reimbursement of transitional assistance and associated sponsor requirements. [PDF]
• 412.10 Changes in the DRG classification system. [PDF]
• 412.100 Special treatment: Renal transplantation centers. [PDF]
• 412.101 Special treatment: Inpatient hospital payment adjustment for low-volume hospitals. [PDF]
• 412.102 Special treatment: Hospitals located in areas that are reclassified from urban to rural as a result of a geographic redesignation. [PDF]
• 412.103 Special treatment: Hospitals located in urban areas and that apply for reclassification as rural. [PDF]
• 412.104 Special treatment: Hospitals with high percentage of ESRD discharges. [PDF]
• 412.105 Special treatment: Hospitals that incur indirect costs for graduate medical education programs. [PDF]
• 412.106 Special treatment: Hospitals that serve a disproportionate share of low-income patients. [PDF]
• 412.107 Special treatment: Hospitals that receive an additional update for FYs 1998 and 1999. [PDF]
• 412.108 Special treatment: Medicare-dependent, small rural hospitals. [PDF]
• 412.109 Special treatment: Essential access community hospitals (EACHs). [PDF]
• 412.110 Total Medicare payment. [PDF]
• 412.112 Payments determined on a per case basis. [PDF]
• 412.113 Other payments. [PDF]
• 412.115 Additional payments. [PDF]
• 412.116 Method of payment. [PDF]
• 412.120 Reductions to total payments. [PDF]
• 412.125 Effect of change of ownership on payments under the prospective payment systems. [PDF]
• 412.130 Retroactive adjustments for incorrectly excluded hospitals and units. [PDF]
• 412.2 Basis of payment. [PDF]
• 412.20 Hospital services subject to the prospective payment systems. [PDF]
• 412.200 General provisions. [PDF]
• 412.204 Payment to hospitals located in Puerto Rico. [PDF]
• 412.208 Puerto Rico rates for Federal fiscal year 1988. [PDF]
• 412.210 Puerto Rico rates for Federal fiscal years 1989 through 2003. [PDF]
• 412.211 Puerto Rico rates for Federal fiscal year 2004 and subsequent fiscal years. [PDF]
• 412.212 National rate. [PDF]
• 412.22 Excluded hospitals and hospital units: General rules. [PDF]
• 412.220 Special treatment of certain hospitals located in Puerto Rico. [PDF]
• 412.23 Excluded hospitals: Classifications. [PDF]
• 412.230 Criteria for an individual hospital seeking redesignation to another rural area or an urban area. [PDF]
• 412.232 Criteria for all hospitals in a rural county seeking urban redesignation. [PDF]
• 412.234 Criteria for all hospitals in an urban county seeking redesignation to another urban area. [PDF]
• 412.235 Criteria for all hospitals in a State seeking a statewide wage index redesignation. [PDF]
• 412.246 MGCRB members. [PDF]
• 412.248 Number of members needed for a decision or a hearing. [PDF]
• 412.25 Excluded hospital units: Common requirements. [PDF]
• 412.250 Sources of MGCRB's authority. [PDF]
• 412.252 Applications. [PDF]
• 412.254 Proceedings before MGCRB. [PDF]
• 412.256 Application requirements. [PDF]
• 412.258 Parties to MGCRB proceeding. [PDF]
• 412.260 Time and place of the oral hearing. [PDF]
• 412.262 Disqualification of an MGCRB member. [PDF]
• 412.264 Evidence and comments in MGCRB proceeding. [PDF]
• 412.266 Availability of wage data. [PDF]
• 412.268 Subpoenas. [PDF]
• 412.27 Excluded psychiatric units: Additional requirements. [PDF]
• 412.270 Witnesses. [PDF]
• 412.272 Record of proceedings before the MGCRB. [PDF]
• 412.273 Withdrawing an application, terminating an approved 3-year reclassification, or canceling a previous withdrawal or termination. [PDF]
• 412.274 Scope and effect of an MGCRB decision. [PDF]
• 412.278 Administrator's review. [PDF]
• 412.280 Representation. [PDF]
• 412.29 Excluded rehabilitation units: Additional requirements. [PDF]
• 412.30 Exclusion of new rehabilitation units and expansion of units already excluded. [PDF]
• 412.300 Scope of subpart and definition. [PDF]
• 412.302 Introduction to capital costs. [PDF]
• 412.304 Implementation of the capital prospective payment system. [PDF]
• 412.308 Determining and updating the Federal rate. [PDF]
• 412.312 Payment based on the Federal rate. [PDF]
• 412.316 Geographic adjustment factors. [PDF]
• 412.320 Disproportionate share adjustment factor. [PDF]
• 412.322 Indirect medical education adjustment factor. [PDF]
• 412.324 General description. [PDF]
• 412.328 Determining and updating the hospital-specific rate. [PDF]
• 412.331 Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution. [PDF]
• 412.332 Payment based on the hospital-specific rate. [PDF]
• 412.336 Transition period payment methodologies. [PDF]
• 412.340 Fully prospective payment methodology. [PDF]
• 412.344 Hold-harmless payment methodology. [PDF]
• 412.348 Exception payments. [PDF]
• 412.352 Budget neutrality adjustment. [PDF]
• 412.370 General provisions for hospitals located in Puerto Rico. [PDF]
• 412.374 Payments to hospitals located in Puerto Rico. [PDF]
• 412.4 Discharges and transfers. [PDF]
• 412.40 General requirements. [PDF]
• 412.400 Basis and scope of subpart. [PDF]
• 412.402 Definitions. [PDF]
• 412.404 Conditions for payment under the prospective payment system for inpatient hospital services of psychiatric facilities. [PDF]
• 412.42 Limitations on charges to beneficiaries. [PDF]
• 412.424 Methodology for calculating the Federal per diem payment amount. [PDF]
• 412.426 Transition period. [PDF]
• 412.428 Publication of Updates to the inpatient psychiatric facility prospective payment system. [PDF]
• 412.432 Method of payment under the inpatient psychiatric facility prospective payment system. [PDF]
• 412.44 Medical review requirements: Admissions and quality review. [PDF]
• 412.46 Medical review requirements: Physician acknowledgement. [PDF]
• 412.50 Furnishing of inpatient hospital services directly or under arrangements. [PDF]
• 412.500 Basis and scope of subpart. [PDF]
• 412.503 Definitions. [PDF]
• 412.505 Conditions for payment under the prospective payment system for long-term care hospitals. [PDF]
• 412.507 Limitation on charges to beneficiaries. [PDF]
• 412.508 Medical review requirements. [PDF]
• 412.509 Furnishing of inpatient hospital services directly or under arrangement. [PDF]
• 412.511 Reporting and recordkeeping requirements. [PDF]
• 412.513 Patient classification system. [PDF]
• 412.515 LTC-DRG weighting factors. [PDF]
• 412.517 Revision of LTC-DRG group classifications and weighting factors. [PDF]
• 412.52 Reporting and recordkeeping requirements. [PDF]
• 412.521 Basis of payment. [PDF]
• 412.523 Methodology for calculating the Federal prospective payment rates. [PDF]
• 412.529 Special payment provision for short-stay outliers. [PDF]
• 412.531 Special payment provisions when an interruption of a stay occurs in a long-term care hospital. [PDF]
• 412.532 Special payment provisions for patients who are transferred to onsite providers and readmitted to a long-term care hospital. [PDF]
• 412.533 Transition payments. [PDF]
• 412.534 Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. [PDF]
• 412.535 Publication of the Federal prospective payment rates. [PDF]
• 412.536 Special payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharged Medicare patients admitted from a hospital not located in the same building or on the same campus as the long-term care hospital or satellit [PDF]
• 412.541 Method of payment under the long-term care hospital prospective payment system. [PDF]
• 412.6 Cost reporting periods subject to the prospective payment systems. [PDF]
• 412.60 DRG classification and weighting factors. [PDF]
• 412.600 Basis and scope of subpart. [PDF]
• 412.602 Definitions. [PDF]
• 412.604 Conditions for payment under the prospective payment system for inpatient rehabilitation facilities. [PDF]
• 412.606 Patient assessments. [PDF]
• 412.608 Patients' rights regarding the collection of patient assessment data. [PDF]
• 412.610 Assessment schedule. [PDF]
• 412.612 Coordination of the collection of patient assessment data. [PDF]
• 412.616 Release of information collected using the patient assessment instrument. [PDF]
• 412.618 Assessment process for interrupted stays. [PDF]
• 412.62 Federal rates for inpatient operating costs for fiscal year 1984. [PDF]
• 412.620 Patient classification system. [PDF]
• 412.622 Basis of payment. [PDF]
• 412.624 Methodology for calculating the Federal prospective payment rates. [PDF]
• 412.626 Transition period. [PDF]
• 412.628 Publication of the Federal prospective payment rates. [PDF]
• 412.63 Federal rates for inpatient operating costs for Federal fiscal years 1984 through 2004. [PDF]
• 412.630 Limitation on review. [PDF]
• 412.64 Federal rates for inpatient operating costs for Federal fiscal year 2005 and subsequent fiscal years. [PDF]
• 412.70 General description. [PDF]
• 412.71 Determination of base-year inpatient operating costs. [PDF]
• 412.73 Determination of the hospital-specific rate based on a Federal fiscal year 1982 base period. [PDF]
• 412.77 Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 1996 base period. [PDF]
• 412.78 Recovery of excess transition period payment amounts resulting from unlawful claims. [PDF]
• 412.79 Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent, small rural hospitals based on a Federal fiscal year 2002 base period. [PDF]
• 412.8 Publication of schedules for determining prospective payment rates. [PDF]
• 412.84 Payment for extraordinarily high-cost cases (cost outliers). [PDF]
• 412.86 Payment for extraordinarily high-cost day outliers. [PDF]
• 412.87 Additional payment for new medical services and technologies: General provisions. [PDF]
• 412.88 Additional payment for new medical service or technology. [PDF]
• 412.89 Payment adjustment for certain replaced devices. [PDF]
• 412.90 General rules. [PDF]
• 412.92 Special treatment: Sole community hospitals. [PDF]
• 412.96 Special treatment: Referral centers. [PDF]
• 422.100 General requirements. [PDF]
• 422.101 Requirements relating to basic benefits. [PDF]
• 422.102 Supplemental benefits. [PDF]
• 422.103 Benefits under an MA MSA plan. [PDF]
• 422.104 Special rules on supplemental benefits for MA MSA plans. [PDF]
• 422.105 Special rules for self-referral and point of service option. [PDF]
• 422.106 Coordination of benefits with employer or union group health plans and Medicaid. [PDF]
• 422.108 Medicare secondary payer (MSP) procedures. [PDF]
• 422.109 Effect of national coverage determinations (NCDs) and legislative changes in benefits. [PDF]
• 422.111 Disclosure requirements. [PDF]
• 422.112 Access to services. [PDF]
• 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance and post-stabilization care services. [PDF]
• 422.114 Access to services under an MA private fee-for-service plan. [PDF]
• 422.118 Confidentiality and accuracy of enrollee records. [PDF]
• 422.128 Information on advance directives. [PDF]
• 422.132 Protection against liability and loss of benefits. [PDF]
• 422.133 Return to home skilled nursing facility. [PDF]
• 422.152 Quality improvement program. [PDF]
• 422.156 Compliance deemed on the basis of accreditation. [PDF]
• 422.157 Accreditation organizations. [PDF]
• 422.158 Procedures for approval of accreditation as a basis for deeming compliance. [PDF]
• 422.2 Definitions. [PDF]
• 422.200 Basis and scope. [PDF]
• 422.202 Participation procedures. [PDF]
• 422.204 Provider selection and credentialing. [PDF]
• 422.205 Provider antidiscrimination rules. [PDF]
• 422.206 Interference with health care professionals' advice to enrollees prohibited. [PDF]
• 422.208 Physician incentive plans: requirements and limitations. [PDF]
• 422.210 Assurances to CMS. [PDF]
• 422.212 Limitations on provider indemnification. [PDF]
• 422.214 Special rules for services furnished by noncontract providers. [PDF]
• 422.216 Special rules for MA private fee-for-service plans. [PDF]
• 422.220 Exclusion of services furnished under a private contract. [PDF]
• 422.250 Basis and scope. [PDF]
• 422.252 Terminology. [PDF]
• 422.254 Submission of bids. [PDF]
• 422.256 Review, negotiation, and approval of bids. [PDF]
• 422.258 Calculation of benchmarks. [PDF]
• 422.262 Beneficiary premiums. [PDF]
• 422.264 Calculation of savings. [PDF]
• 422.266 Beneficiary rebates. [PDF]
• 422.270 Incorrect collections of premiums and cost-sharing. [PDF]
• 422.300 Basis and scope. [PDF]
• 422.304 Monthly payments. [PDF]
• 422.306 Annual MA capitation rates. [PDF]
• 422.308 Adjustments to capitation rates, benchmarks, bids, and payments. [PDF]
• 422.310 Risk adjustment data. [PDF]
• 422.312 Announcement of annual capitation rate, benchmarks, and methodology changes. [PDF]
• 422.314 Special rules for beneficiaries enrolled in MA MSA plans. [PDF]
• 422.316 Special rules for payments to Federally qualified health centers. [PDF]
• 422.318 Special rules for coverage that begins or ends during an inpatient hospital stay. [PDF]
• 422.320 Special rules for hospice care. [PDF]
• 422.322 Source of payment and effect of MA plan election on payment. [PDF]
• 422.324 Payments to MA organizations for graduate medical education costs. [PDF]
• 422.352 Basic requirements. [PDF]
• 422.354 Requirements for affiliated providers. [PDF]
• 422.356 Determining substantial financial risk and majority financial interest. [PDF]
• 422.370 Waiver of State licensure. [PDF]
• 422.372 Basis for waiver of State licensure. [PDF]
• 422.374 Waiver request and approval process. [PDF]
• 422.376 Conditions of the waiver. [PDF]
• 422.378 Relationship to State law. [PDF]
• 422.380 Solvency standards. [PDF]
• 422.382 Minimum net worth amount. [PDF]
• 422.384 Financial plan requirement. [PDF]
• 422.386 Liquidity. [PDF]
• 422.388 Deposits. [PDF]
• 422.390 Guarantees. [PDF]
• 422.4 Types of MA plans. [PDF]
• 422.400 State licensure requirement. [PDF]
• 422.402 Federal preemption of State law. [PDF]
• 422.404 State premium taxes prohibited. [PDF]
• 422.451 Moratorium on new local preferred provider organization plans. [PDF]
• 422.455 Special rules for MA Regional Plans. [PDF]
• 422.458 Risk sharing with regional MA organizations for 2006 and 2007. [PDF]
• 422.50 Eligibility to elect an MA plan. [PDF]
• 422.500 Scope and definitions. [PDF]
• 422.501 Application requirements. [PDF]
• 422.502 Evaluation and determination procedures. [PDF]
• 422.503 General provisions. [PDF]
• 422.504 Contract provisions. [PDF]
• 422.505 Effective date and term of contract. [PDF]
• 422.506 Nonrenewal of contract. [PDF]
• 422.508 Modification or termination of contract by mutual consent. [PDF]
• 422.510 Termination of contract by CMS. [PDF]
• 422.512 Termination of contract by the MA organization. [PDF]
• 422.514 Minimum enrollment requirements. [PDF]
• 422.516 Reporting requirements. [PDF]
• 422.52 Eligibility to elect an MA plan for special needs individuals. [PDF]
• 422.520 Prompt payment by MA organization. [PDF]
• 422.521 Effective date of new significant regulatory requirements. [PDF]
• 422.527 Agreements with Federally qualified health centers. [PDF]
• 422.54 Continuation of enrollment for MA local plans. [PDF]
• 422.550 General provisions. [PDF]
• 422.552 Novation agreement requirements. [PDF]
• 422.553 Effect of leasing of an MA organization's facilities. [PDF]
• 422.56 Enrollment in an MA MSA plan. [PDF]
• 422.561 Definitions. [PDF]
• 422.562 General provisions. [PDF]
• 422.564 Grievance procedures. [PDF]
• 422.566 Organization determinations. [PDF]
• 422.568 Standard timeframes and notice requirements for organization determinations. [PDF]
• 422.57 Limited enrollment under MA RFB plans. [PDF]
• 422.570 Expediting certain organization determinations. [PDF]
• 422.572 Timeframes and notice requirements for expedited organization determinations. [PDF]
• 422.574 Parties to the organization determination. [PDF]
• 422.576 Effect of an organization determination. [PDF]
• 422.578 Right to a reconsideration. [PDF]
• 422.580 Reconsideration defined. [PDF]
• 422.582 Request for a standard reconsideration. [PDF]
• 422.584 Expediting certain reconsiderations. [PDF]
• 422.586 Opportunity to submit evidence. [PDF]
• 422.590 Timeframes and responsibility for reconsiderations. [PDF]
• 422.592 Reconsideration by an independent entity. [PDF]
• 422.594 Notice of reconsidered determination by the independent entity. [PDF]
• 422.596 Effect of a reconsidered determination. [PDF]
• 422.6 Cost-sharing in enrollment-related costs. [PDF]
• 422.60 Election process. [PDF]
• 422.612 Judicial review. [PDF]
• 422.616 Reopening and revising determinations and decisions. [PDF]
• 422.618 How an MA organization must effectuate standard reconsidered determinations or decisions. [PDF]
• 422.619 How an MA organization must effectuate expedited reconsidered determinations. [PDF]
• 422.62 Election of coverage under an MA plan. [PDF]
• 422.620 Notifying enrollees of hospital discharge appeal rights. [PDF]
• 422.622 Requesting immediate QIO review of the decision to discharge from the inpatient hospital. [PDF]
• 422.624 Notifying enrollees of termination of provider services. [PDF]
• 422.626 Fast-track appeals of service terminations to independent review entities (IREs). [PDF]
• 422.64 Information about the MA program. [PDF]
• 422.641 Contract determinations. [PDF]
• 422.644 Notice of contract determination. [PDF]
• 422.648 Reconsideration: Applicability. [PDF]
• 422.650 Request for reconsideration. [PDF]
• 422.652 Opportunity to submit evidence. [PDF]
• 422.654 Reconsidered determination. [PDF]
• 422.656 Notice of reconsidered determination. [PDF]
• 422.66 Coordination of enrollment and disenrollment through MA organizations. [PDF]
• 422.660 Right to a hearing. [PDF]
• 422.662 Request for hearing. [PDF]
• 422.664 Postponement of effective date of a contract determination when a request for a hearing with respect to a contract determination is filed timely. [PDF]
• 422.666 Designation of hearing officer. [PDF]
• 422.668 Disqualification of hearing officer. [PDF]
• 422.670 Time and place of hearing. [PDF]
• 422.674 Authority of representatives. [PDF]
• 422.678 Evidence. [PDF]
• 422.68 Effective dates of coverage and change of coverage. [PDF]
• 422.680 Witnesses. [PDF]
• 422.682 Discovery. [PDF]
• 422.684 Prehearing. [PDF]
• 422.686 Record of hearing. [PDF]
• 422.688 Authority of hearing officer. [PDF]
• 422.690 Notice and effect of hearing decision. [PDF]
• 422.692 Review by the Administrator. [PDF]
• 422.694 Effect of Administrator's decision. [PDF]
• 422.698 Effect of revised determination. [PDF]
• 422.74 Disenrollment by the MA organization. [PDF]
• 422.750 Kinds of sanctions. [PDF]
• 422.752 Basis for imposing sanctions. [PDF]
• 422.756 Procedures for imposing sanctions. [PDF]
• 422.758 Maximum amount of civil money penalties imposed by CMS. [PDF]
• 422.760 Other applicable provisions. [PDF]
• 422.80 Approval of marketing materials and election forms. [PDF]
• 436.10 State plan requirements. [PDF]
• 436.100 Scope. [PDF]
• 436.1000 Scope. [PDF]
• 436.1002 FFP for services. [PDF]
• 436.1003 Recipients overcoming certain conditions of eligibility. [PDF]
• 436.1004 FFP in expenditures for medical assistance for individuals who have declared United States citizenship or nationality under section 1137(d) of the Act and with respect to whom the State has not documented citizenship and identity. [PDF]
• 436.1005 Institutionalized individuals. [PDF]
• 436.1006 Definitions relating to institutional status. [PDF]
• 436.110 Individuals receiving cash assistance. [PDF]
• 436.1100 Basis and scope. [PDF]
• 436.1101 Definitions related to presumptive eligibility period for children. [PDF]
• 436.1102 General rules. [PDF]
• 436.111 Individuals who are not eligible for cash assistance because of a requirement not applicable under Medicaid. [PDF]
• 436.112 Individuals who would be eligible for cash assistance except for increased OASDI under Pub. L. 92-336 (July 1, 1972). [PDF]
• 436.114 Individuals deemed to be receiving AFDC. [PDF]
• 436.116 Families terminated from AFDC because of increased earnings or hours of employment. [PDF]
• 436.118 Children for whom adoption assistance or foster care maintenance payments are made. [