StacksVerified U.S. regulatory reference

42 CFR §456.650

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
  1. (a)Basis. Section 1903(g) of the Act requires that FFP for long-stay inpatient services at a level of care be reduced, by a specified formula, for any quarter in which a State fails to make a satisfactory showing that it has an effective program of utilization control for that level of care.
  2. (b)Purpose. This subpart specifies—
    1. (1)What States must do to make a satisfactory showing;
    2. (2)How the Administrator will determine whether reductions will be imposed; and
    3. (3)How the required reductions will be implemented.
  3. (c)Scope. The reductions required by this subpart do not apply to—
    1. (1)Services provided under a contract with a health maintenance organization; or
    2. (2)Facilities in which a QIO is performing medical and utilization reviews under contract with the Medicaid agency in accordance with § 431.630 of this chapter.