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Code of Federal Regulations (Last Updated: May 6, 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 D - State Children'S Health Insurance Programs (Schips) |
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Part 457 - Allotments and Grants to States |
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Subpart L - Managed Care |
| Quality Measurement and Improvement; External Quality Review |
| § 457.1240 - Quality measurement and improvement. |
| § 457.1250 - External quality review. |
| MCO, PIHP, and PAHP Standards |
| § 457.1230 - Access standards. |
| § 457.1233 - Structure and operation standards. |
| General Provisions |
| § 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). |
| Sanctions |
| § 457.1270 - Sanctions. |
| § 457.1280 - Conditions necessary to contract as an MCO, PAHP, or PIHP. |
| § 457.1285 - Program integrity safeguards. |
| Enrollee Rights and Protections |
| § 457.1220 - Enrollee rights. |
| § 457.1222 - Provider-enrollee communication. |
| § 457.1224 - Marketing activities. |
| § 457.1226 - Liability for payment. |
| § 457.1228 - Emergency and poststabilization services. |
| Grievance System |
| § 457.1260 - Grievance system. |
| State Responsibilities |
| § 457.1210 - Enrollment process. |
| § 457.1212 - Disenrollment. |
| § 457.1214 - Conflict of interest safeguards. |
| § 457.1216 - Continued services to enrollees. |
| § 457.1218 - Network adequacy standards. |