| Title 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE &
MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)
PART 438--MANAGED CARE
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438.1 | Basis and scope. |
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438.2 | Definitions. |
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438.6 | Contract requirements. |
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438.8 | Provisions that apply to PIHPs and PAHPs. |
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438.10 | Information requirements. |
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438.12 | Provider discrimination prohibited. |
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438.50 | State Plan requirements. |
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438.52 | Choice of MCOs, PIHPs, PAHPs, and PCCMs. |
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438.56 | Disenrollment: Requirements and limitations. |
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438.58 | Conflict of interest safeguards. |
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438.60 | Limit on payment to other providers. |
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438.62 | Continued services to recipients. |
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438.66 | Monitoring procedures. |
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438.100 | Enrollee rights. |
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438.102 | Provider-enrollee communications. |
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438.104 | Marketing activities. |
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438.106 | Liability for payment. |
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438.108 | Cost sharing. |
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438.114 | Emergency and poststabilization services. |
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438.116 | Solvency standards. |
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438.200 | Scope. |
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438.202 | State responsibilities. |
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438.204 | Elements of State quality strategies. |
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438.206 | Availability of services. |
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438.207 | Assurances of adequate capacity and services. |
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438.208 | Coordination and continuity of care. |
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438.210 | Coverage and authorization of services. |
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438.214 | Provider selection. |
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438.218 | Enrollee information. |
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438.224 | Confidentiality. |
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438.226 | Enrollment and disenrollment. |
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438.228 | Grievance systems. |
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438.230 | Subcontractual relationships and delegation. |
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438.236 | Practice guidelines. |
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438.240 | Quality assessment and performance improvement program. |
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438.242 | Health information systems. |
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438.310 | Basis, scope, and applicability. |
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438.320 | Definitions. |
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438.350 | State responsibilities. |
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438.352 | External quality review protocols. |
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438.354 | Qualifications of external quality review organizations. |
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438.356 | State contract options. |
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438.358 | Activities related to external quality review. |
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438.360 | Nonduplication of mandatory activities. |
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438.362 | Exemption from external quality review. |
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438.364 | External quality review results. |
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438.370 | Federal financial participation. |
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438.400 | Statutory basis and definitions. |
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438.402 | General requirements. |
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438.404 | Notice of action. |
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438.406 | Handling of grievances and appeals. |
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438.408 | Resolution and notification: Grievances and appeals. |
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438.410 | Expedited resolution of appeals. |
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438.414 | Information about the grievance system to providers and subcontractors. |
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438.416 | Recordkeeping and reporting requirements. |
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438.420 | Continuation of benefits while the MCO or PIHP appeal and the State fair hearing are pending. |
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438.424 | Effectuation of reversed appeal resolutions. |
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438.600 | Statutory basis. |
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438.602 | Basic rule. |
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438.604 | Data that must be certified. |
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438.606 | Source, content, and timing of certification. |
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438.608 | Program integrity requirements. |
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438.610 | Prohibited affiliations with individuals debarred by Federal agencies. |
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438.700 | Basis for imposition of sanctions. |
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438.702 | Types of intermediate sanctions. |
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438.704 | Amounts of civil money penalties. |
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438.706 | Special rules for temporary management. |
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438.708 | Termination of an MCO or PCCM contract. |
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438.710 | Due process: Notice of sanction and pre-termination hearing. |
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438.722 | Disenrollment during termination hearing process. |
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438.724 | Notice to CMS. |
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438.726 | State plan requirement. |
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438.730 | Sanction by CMS: Special rules for MCOs |
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438.802 | Basic requirements. |
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438.806 | Prior approval. |
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438.808 | Exclusion of entities. |
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438.810 | Expenditures for enrollment broker services. |
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438.812 | Costs under risk and nonrisk contracts. |
