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Code of Federal Regulations (Last Updated: October 10, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter C - Medical Assistance Programs |
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Part 431 - State Organization and General Administration |
| § 431.1 - Purpose. |
| 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. |
| § 431.57 - Waiver of cost-sharing requirements. |
| § 431.60 - Beneficiary access to and exchange of data. |
| § 431.61 - Access to and exchange of health data for providers and payers. |
| § 431.70 - xxx |
| § 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 |
| § 431.151 - Scope and applicability. |
| § 431.152 - State plan requirements. |
| § 431.153 - Evidentiary hearing. |
| § 431.154 - Informal reconsideration for ICFs/IID. |
| Subpart E - Fair Hearings for Applicants and Beneficiaries |
| Procedures |
| § 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. |
| Federal Financial Participation |
| § 431.250 - Federal financial participation. |
| Right to Hearing |
| § 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. |
| Notice |
| § 431.210 - Content of notice. |
| § 431.211 - Advance notice. |
| § 431.213 - Exceptions from advance notice. |
| § 431.214 - Notice in cases of probable fraud. |
| General Provisions |
| § 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. |
| 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 |
| § 431.400 - Basis and purpose. |
| § 431.404 - Definitions. |
| § 431.408 - State public notice process. |
| § 431.412 - Application procedures. |
| § 431.416 - Federal public notice and approval process. |
| § 431.420 - Monitoring and compliance. |
| § 431.424 - Evaluation requirements. |
| § 431.428 - Reporting requirements. |
| Subparts H--L - XXX |
| 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). |
| § 431.636 - Coordination of Medicaid with the Children's Health Insurance Program (CHIP). |
| 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 O - XXX |
| Subpart P - Quality Control |
| § 431.822 - Resolution of differences in State and Federal case eligibility or payment findings. |
| § 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. |
| General Provisions |
| § 431.802 - Basis. |
| Medicaid Quality Control (MQC) Claims Processing Assessment System |
| Medicaid Eligibility Quality Control (MEQC) Program |
| § 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. |
| Federal Financial Participation |
| § 431.865 - Disallowance of Federal financial participation for erroneous State payments (for annual assessment periods ending after July 1, 1990). |
| §§ 431.861--431.864 - [Reserved] |
| 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. |
| § 431.974 - Basic elements of Medicaid and CHIP eligibility reviews. |
| § 431.978 - Eligibility sampling plan and procedures. |
| § 431.980 - Eligibility review procedures. |
| § 431.988 - Eligibility case review completion deadlines and submittal of reports. |
| § 431.992 - Corrective action plan. |
| § 431.998 - Difference resolution and appeal process. |
| § 431.1002 - Recoveries. |
| § 431.1010 - xxx |