Part 457 — Allotments and Grants to States
Subpart A — Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies
- § 457.1— Program description.
- § 457.2— Basis and scope of subchapter D.
- § 457.10— Definitions and use of terms.
- § 457.30— Basis, scope, and applicability of subpart A.
- § 457.40— State program administration.
- § 457.50— State plan.
- § 457.60— Amendments.
- § 457.65— Effective date and duration of State plans and plan amendments.
- § 457.70— Program options.
- § 457.80— Current State child health insurance coverage and coordination.
- § 457.90— Outreach.
- § 457.110— Enrollment assistance and information requirements.
- § 457.120— Public involvement in program development.
- § 457.125— Provision of child health assistance to American Indian and Alaska Native children.
- § 457.130— Civil rights assurance.
- § 457.135— Assurance of compliance with other provisions.
- § 457.140— Budget.
- § 457.150— CMS review of State plan material.
- § 457.160— Notice and timing of CMS action on State plan material.
- § 457.170— Withdrawal process.
Subpart B — General Administration—Reviews and Audits; Withholding for Failure to Comply; Deferral and Disallowance of Claims; Reduction of Federal Medical Payments
- § 457.200— Program reviews.
- § 457.202— Audits.
- § 457.203— Administrative and judicial review of action on State plan material.
- § 457.204— Withholding of payment for failure to comply with Federal requirements.
- § 457.206— Administrative appeals under CHIP.
- § 457.208— Judicial review.
- § 457.216— Treatment of uncashed or canceled (voided) CHIP checks.
- § 457.220— Funds from units of government as the State share of financial participation.
- § 457.222— FFP for equipment.
- § 457.224— FFP: Conditions relating to cost sharing.
- § 457.226— Fiscal policies and accountability.
- § 457.228— Cost allocation.
- § 457.230— FFP for State ADP expenditures.
- § 457.232— Refunding of Federal Share of CHIP overpayments to providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General.
- § 457.236— Audits.
- § 457.238— Documentation of payment rates.
Subpart C — State Plan Requirements: Eligibility, Screening, Applications, and Enrollment
- § 457.300— Basis, scope, and applicability.
- § 457.301— Definitions and use of terms.
- § 457.305— State plan provisions.
- § 457.310— Targeted low-income child.
- § 457.315— Application of modified adjusted gross income and household definition.
- § 457.320— Other eligibility standards.
- § 457.330— Application.
- § 457.340— Application for and enrollment in CHIP.
- § 457.342— Continuous eligibility for children.
- § 457.343— Periodic renewal of CHIP eligibility.
- § 457.344— Changes in circumstances.
- § 457.348— Determinations of Children's Health Insurance Program eligibility by other insurance affordability programs.
- § 457.350— Eligibility screening and enrollment in other insurance affordability programs.
- § 457.351— Coordination involving appeals entities for different insurance affordability programs.
- § 457.353— Monitoring and evaluation of screening process.
- § 457.355— Presumptive eligibility for children.
- § 457.360— Deemed newborn children.
- § 457.370— Alignment with Exchange initial open enrollment period.
- § 457.380— Eligibility verification.
Subpart D — State Plan Requirements: Coverage and Benefits
- § 457.401— Basis, scope, and applicability.
- § 457.402— Definition of child health assistance.
- § 457.410— Health benefits coverage options.
- § 457.420— Benchmark health benefits coverage.
- § 457.430— Benchmark-equivalent health benefits coverage.
- § 457.431— Actuarial report for benchmark-equivalent coverage.
- § 457.440— Existing comprehensive State-based coverage.
- § 457.450— Secretary-approved coverage.
- § 457.470— Prohibited coverage.
- § 457.475— Limitations on coverage: Abortions.
- § 457.480— Prohibited coverage limitations, preexisting condition exclusions, and relation to other laws.
- § 457.490— Delivery and utilization control systems.
- § 457.495— State assurance of access to care and procedures to assure quality and appropriateness of care.
- § 457.496— Parity in mental health and substance use disorder benefits.
Subpart E — State Plan Requirements: Enrollee Financial Responsibilities
- § 457.500— Basis, scope, and applicability.
- § 457.505— General State plan requirements.
- § 457.510— Premiums, enrollment fees, or similar fees: State plan requirements.
- § 457.515— Co-payments, coinsurance, deductibles, or similar cost-sharing charges: State plan requirements.
- § 457.520— Cost sharing for well-baby and well-child care services.
- § 457.525— Public schedule.
- § 457.530— General cost-sharing protection for lower income children.
- § 457.535— Cost-sharing protection to ensure enrollment of American Indians and Alaska Natives.
- § 457.540— Cost-sharing charges for children in families with incomes at or below 150 percent of the FPL.
- § 457.555— Maximum allowable cost-sharing charges on targeted low-income children in families with income from 101 to 150 percent of the FPL.
- § 457.560— Cumulative cost-sharing maximum.
- § 457.570— Disenrollment protections.
Subpart F — Payments to States
- § 457.600— Purpose and basis of this subpart.
- § 457.602— Applicability.
- § 457.606— Conditions for State allotments and Federal payments for a fiscal year.
- § 457.608— Process and calculation of State allotments prior to FY 2009.
- § 457.609— Process and calculation of State allotments for a fiscal year after FY 2008.
- § 457.610— Period of availability for State allotments prior to FY 2009.
- § 457.611— Period of availability for State allotments for a fiscal year after FY 2008.
- § 457.614— General payment process.
- § 457.616— Application and tracking of payments against the fiscal year allotments.
- § 457.618— Ten percent limit on certain Children's Health Insurance Program expenditures.
- § 457.622— Rate of FFP for State expenditures.
- § 457.626— Prevention of duplicate payments.
- § 457.628— Other applicable Federal regulations.
- § 457.630— Grants procedures.
Subpart G — Strategic Planning, Reporting, and Evaluation
- § 457.700— Basis, scope, and applicability.
- § 457.710— State plan requirements: Strategic objectives and performance goals.
- § 457.720— State plan requirement: State assurance regarding data collection, records, and reports.
- § 457.730— Beneficiary access to and exchange of data.
- § 457.731— Access to and exchange of health data for providers and payers.
- § 457.732— Prior authorization requirements.
- § 457.740— State expenditures and statistical reports.
- § 457.750— Annual report.
- § 457.760— Access to published provider directory information.
- § 457.770— Reporting on Health Care Quality Measures.
Subpart H — Substitution of Coverage
Subpart I — Program Integrity
- § 457.900— Basis, scope and applicability.
- § 457.910— State program administration.
- § 457.915— Fraud detection and investigation.
- § 457.925— Preliminary investigation.
- § 457.930— Full investigation, resolution, and reporting requirements.
- § 457.935— Sanctions and related penalties.
- § 457.940— Procurement standards.
- § 457.945— Certification for contracts and proposals.
- § 457.950— Contract and payment requirements including certification of payment-related information.
- § 457.965— Documentation.
- § 457.980— Verification of enrollment and provider services received.
- § 457.985— Integrity of professional advice to enrollees.
- § 457.990— Provider and supplier screening, oversight, and reporting requirements.
Subpart J — Allowable Waivers: General Provisions
Subpart K — State Plan Requirements: Applicant and Enrollee Protections
- § 457.1100— Basis, scope and applicability.
- § 457.1110— Privacy protections.
- § 457.1120— State plan requirement: Description of review process.
- § 457.1130— Program specific review process: Matters subject to review.
- § 457.1140— Program specific review process: Core elements of review.
- § 457.1150— Program specific review process: Impartial review.
- § 457.1160— Program specific review process: Time frames.
- § 457.1170— Program specific review process: Continuation of enrollment.
- § 457.1180— Program specific review process: Notice.
- § 457.1190— Application of review procedures when States offer premium assistance for group health plans.
Subpart L — Managed Care
- § 457.1200— Basis, scope, and applicability.
- § 457.1201— Standard contract requirements.
- § 457.1203— Rate development standards and medical loss ratio.
- § 457.1206— Non-emergency medical transportation PAHPs.
- § 457.1207— Information requirements.
- § 457.1208— Provider discrimination prohibited.
- § 457.1209— Requirements that apply to MCO, PIHP, PAHP, PCCM, and PCCM entity contracts involving Indians, Indian health care provider (IHCP), and Indian managed care entities (IMCE).
- § 457.1210— Enrollment process.
- § 457.1212— Disenrollment.
- § 457.1214— Conflict of interest safeguards.
- § 457.1216— Continued services to enrollees.
- § 457.1218— Network adequacy standards.
- § 457.1220— Enrollee rights.
- § 457.1222— Provider-enrollee communication.
- § 457.1224— Marketing activities.
- § 457.1226— Liability for payment.
- § 457.1228— Emergency and poststabilization services.
- § 457.1230— Access standards.
- § 457.1233— Structure and operation standards.
- § 457.1240— Quality measurement and improvement.
- § 457.1250— External quality review.
- § 457.1260— Grievance system.
- § 457.1270— Sanctions.
- § 457.1280— Conditions necessary to contract as an MCO, PAHP, or PIHP.
- § 457.1285— Program integrity safeguards.