Part 431 — State Organization and General Administration
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
Subpart E — Fair Hearings for Applicants and Beneficiaries
- § 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.
- § 431.210— Content of notice.
- § 431.211— Advance notice.
- § 431.213— Exceptions from advance notice.
- § 431.214— Notice in cases of probable fraud.
- § 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.
- § 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.
- § 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
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 P — Quality Control
- § 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.
- § 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).