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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 434 - Contracts |
| Subpart A - General Provisions |
| § 434.1 - Basis and scope. |
| § 434.2 - Definitions. |
| § 434.4 - State plan requirement. |
| § 434.6 - General requirements for all contracts and subcontracts. |
| Subpart B - Contracts with Fiscal Agents and Private Nonmedical Institutions |
| § 434.10 - Contracts with fiscal agents. |
| § 434.12 - Contracts with private nonmedical institutions. |
| § 434.14 - [Reserved] |
| Subpart C - XXX |
| General Requirements |
| § 434.20 - Basic rules. |
| Additional Requirements |
| § 434.21 - Contracts that must meet additional requirements. |
| § 434.22 - Application of sanctions to risk comprehensive contracts. |
| § 434.23 - Capitation fees. |
| § 434.25 - Coverage and enrollment. |
| § 434.26 - Composition of enrollment. |
| § 434.27 - Termination of enrollment. |
| § 434.28 - Advance directives. |
| § 434.29 - Choice of health professional. |
| § 434.30 - Emergency medical service. |
| § 434.32 - Grievance procedure. |
| § 434.34 - Quality assurance system. |
| § 434.36 - Marketing. |
| § 434.38 - Inspection and audit of HMO's financial records. |
| Subpart D - Contracts With Health Insuring Organizations |
| § 434.40 - Contract requirements. |
| § 434.42 - Application of sanctions to risk comprehensive contracts. |
| § 434.44 - Special rules for certain health insuring organizations. |
| Subpart E - XXX |
| § 434.50 - Proof of HMO or PHP capability. |
| § 434.52 - Furnishing of required services. |
| § 434.53 - Periodic medical audits. |
| § 434.57 - Limit on payment to other providers. |
| § 434.59 - Continued service to recipients whose enrollment is terminated. |
| § 434.61 - Computation of capitation fees. |
| § 434.63 - Monitoring procedures. |
| § 434.65 - Services included in the State plan but not covered by the contract. |
| § 434.67 - Sanctions against HMOs with risk comprehensive contracts. |
| Subpart F - Federal Financial Participation |
| § 434.70 - Conditions for Federal Financial Participation (FFP). |
| § 434.71 - Condition for FFP: Prior approval. |
| § 434.72 - Effect of a final determination that a provisional status HMO is not an HMO. |
| § 434.74 - Costs under risk-basis contracts. |
| § 434.75 - Costs under no-risk contracts. |
| § 434.76 - Costs under fiscal agent contracts. |
| § 434.78 - Right to reconsideration of disallowance. |
| § 434.80 - Condition for FFP in contracts with HMOs. |