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Code of Federal Regulations (Last Updated: July 5, 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 A - General Provisions |
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Part 403 - Special Programs and Projects |
Subpart A - XXX |
Subpart B - Medicare Supplemental Policies |
§ 403.200 - Basis and scope. |
Voluntary Certification Program: General Provisions |
§ 403.231 - Emblem. |
§ 403.232 - Requirements and procedures for obtaining certification. |
§ 403.235 - Review and certification of policies. |
§ 403.239 - Submittal of material to retain certification. |
§ 403.245 - Loss of certification. |
§ 403.248 - Administrative review of CMS determinations. |
Voluntary Certification Program: Loss Ratio Provisions |
§ 403.250 - Loss ratio calculations: General provisions. |
§ 403.251 - Loss ratio date and time frame provisions. |
§ 403.253 - Calculation of benefits. |
§ 403.254 - Calculation of premiums. |
§ 403.256 - Loss ratio supporting data. |
§ 403.258 - Statement of actuarial opinion. |
State Regulatory Programs |
§ 403.220 - Supplemental Health Insurance Panel. |
§ 403.222 - State with an approved regulatory program. |
General Provisions |
§ 403.201 - State regulation of insurance policies. |
§ 403.205 - Medicare supplemental policy. |
§ 403.206 - General standards for Medicare supplemental policies. |
§ 403.210 - NAIC model standards. |
§ 403.215 - Loss ratio standards. |
Subpart C - Recognition of State Reimbursement Control Systems |
§ 403.300 - Basis and purpose. |
§ 403.302 - Definitions. |
§ 403.304 - Minimum requirements for State systems - discretionary approval. |
§ 403.306 - Additional requirements for State systems - mandatory approval. |
§ 403.308 - State systems under demonstration projects - mandatory approval. |
§ 403.310 - Reduction in payments. |
§ 403.312 - Submittal of application. |
§ 403.314 - Evaluation of State systems. |
§ 403.316 - Reconsideration of certain denied applications. |
§ 403.318 - Approval of State systems. |
§ 403.320 - CMS review and monitoring of State systems. |
§ 403.321 - State systems for hospital outpatient services. |
§ 403.322 - Termination of agreements for Medicare recognition of State systems. |
Subparts D--F - XXX |
Subpart E - Beneficiary Counseling and Assistance Grants |
§ 403.500 - Basis, scope, and definition. |
§ 403.501 - Eligibility for grants. |
§ 403.502 - Availability of grants. |
§ 403.504 - Number and size of grants. |
§ 403.508 - Limitations. |
§ 403.510 - Reporting requirements. |
§ 403.512 - Administration. |
Subpart G - Religious Nonmedical Health Care Institutions - Benefits, Conditions of Participation, and Payment |
§ 403.700 - Basis and purpose. |
§ 403.702 - Definitions and terms. |
§ 403.720 - Conditions for coverage. |
§ 403.724 - Valid election requirements. |
§ 403.730 - Condition of participation: Patient rights. |
§ 403.732 - Condition of participation: Quality assessment and performance improvement. |
§ 403.734 - Condition of participation: Food services. |
§ 403.736 - Condition of participation: Discharge planning. |
§ 403.738 - Condition of participation: Administration. |
§ 403.740 - Condition of participation: Staffing. |
§ 403.742 - Condition of participation: Physical environment. |
§ 403.744 - Condition of participation: Life safety from fire. |
§ 403.745 - Condition of participation: Building safety. |
§ 403.746 - Condition of participation: Utilization review. |
§ 403.748 - Condition of participation: Emergency preparedness. |
§ 403.750 - Estimate of expenditures and adjustments. |
§ 403.752 - Payment provisions. |
§ 403.754 - Monitoring expenditure level. |
§ 403.756 - Sunset provision. |
§ 403.764 - Basis and purpose of religious nonmedical health care institutions providing home service. |
§ 403.766 - Requirements for coverage and payment of RNHCI home services. |
§ 403.768 - Excluded services. |
§ 403.770 - Payments for home services. |
Subpart H - Medicare Prescription Drug Discount Card and Transitional Assistance Program |
§ 403.800 - Basis and scope. |
§ 403.802 - Definitions. |
§ 403.804 - General rules for solicitation, application and Medicare endorsement period. |
§ 403.806 - Sponsor requirements for eligibility for endorsement. |
§ 403.807 - Application process. |
§ 403.808 - Use of transitional assistance funds. |
§ 403.810 - Eligibility and reconsiderations. |
§ 403.811 - Enrollment and disenrollment and associated endorsed sponsor requirements. |
§ 403.812 - HIPAA privacy, security, administrative data standards, and national identifiers. |
§ 403.813 - Marketing limitations and record retention requirements. |
§ 403.814 - Special rules concerning Part C organizations and Medicare cost plans and their enrollees. |
§ 403.815 - Special rules concerning States. |
§ 403.816 - Special rules concerning long-term care and I/T/U pharmacies. |
§ 403.817 - Special rules concerning the territories. |
§ 403.820 - Sanctions, penalties, and termination. |
§ 403.822 - Reimbursement of transitional assistance and associated sponsor requirements. |
Subpart I - Transparency Reports and Reporting of Physician Ownership or Investment Interests |
§ 403.900 - Purpose and scope. |
§ 403.902 - Definitions. |
§ 403.904 - Reports of payments or other transfers of value to covered recipients. |
§ 403.906 - Reports of physician ownership and investment interests. |
§ 403.908 - Procedures for electronic submission of reports. |
§ 403.910 - Delayed publication for payments made under product research or development agreements and clinical investigations. |
§ 403.912 - Penalties for failure to report. |
§ 403.914 - Preemption of State laws. |
Subpart K - Access to Identifiable Data for the Center for Medicare and Medicaid Models |
§ 403.1100 - Purpose and scope. |
§ 403.1105 - Definitions. |
§ 403.1110 - Evaluation of models. |
Subpart L - Requirements for Direct-to-Consumer Television Advertisements of Drugs and Biological Products To Include the List Price of That Advertised Product |
§ 403.1200 - Scope. |
§ 403.1201 - Definitions. |
§ 403.1202 - Pricing information. |
§ 403.1203 - Specific presentation requirements. |
§ 403.1204 - Compliance. |