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Section 438.1
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Definitions |
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Section 438.2
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Contract requirements |
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Section 438.6
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Provisions that apply to PIHPs and PAHPs |
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Section 438.8
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Information requirements |
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Section 438.10
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Provider discrimination prohibited |
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Section 438.12
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State Plan requirements |
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Section 438.50
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Choice of MCOs, PIHPs, PAHPs, and PCCMs |
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Section 438.52
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Disenrollment: Requirements and limitations |
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Section 438.56
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Conflict of interest safeguards |
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Section 438.58
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Limit on payment to other providers |
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Section 438.60
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Continued services to beneficiaries |
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Section 438.62
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Monitoring procedures |
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Section 438.66
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Enrollee rights |
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Section 438.100
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Provider-enrollee communications |
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Section 438.102
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Marketing activities |
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Section 438.104
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Liability for payment |
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Section 438.106
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Cost sharing |
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Section 438.108
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Emergency and poststabilization services |
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Section 438.114
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Solvency standards |
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Section 438.116
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Scope |
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Section 438.200
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State responsibilities |
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Section 438.202
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Elements of State quality strategies |
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Section 438.204
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Availability of services |
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Section 438.206
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Assurances of adequate capacity and services |
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Section 438.207
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Coordination and continuity of care |
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Section 438.208
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Coverage and authorization of services |
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Section 438.210
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Provider selection |
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Section 438.214
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Enrollee information |
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Section 438.218
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Confidentiality |
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Section 438.224
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Enrollment and disenrollment |
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Section 438.226
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Grievance systems |
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Section 438.228
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Subcontractual relationships and delegation |
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Section 438.230
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Practice guidelines |
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Section 438.236
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Quality assessment and performance improvement program |
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Section 438.240
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Health information systems |
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Section 438.242
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Basis, scope, and applicability |
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Section 438.310
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Definitions |
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Section 438.320
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State responsibilities |
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Section 438.350
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External quality review protocols |
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Section 438.352
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Qualifications of external quality review organizations |
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Section 438.354
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State contract options |
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Section 438.356
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Activities related to external quality review |
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Section 438.358
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Nonduplication of mandatory activities |
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Section 438.360
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Exemption from external quality review |
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Section 438.362
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External quality review results |
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Section 438.364
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Federal financial participation |
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Section 438.370
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Statutory basis and definitions |
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Section 438.400
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General requirements |
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Section 438.402
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Notice of action |
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Section 438.404
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Handling of grievances and appeals |
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Section 438.406
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Resolution and notification: Grievances and appeals |
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Section 438.408
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Expedited resolution of appeals |
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Section 438.410
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Information about the grievance system to providers and subcontractors |
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Section 438.414
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Recordkeeping and reporting requirements |
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Section 438.416
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Continuation of benefits while the MCO or PIHP appeal and the State fair hearing are pending |
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Section 438.420
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Effectuation of reversed appeal resolutions |
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Section 438.424
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Statutory basis |
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Section 438.600
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Basic rule |
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Section 438.602
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Data that must be certified |
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Section 438.604
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Source, content, and timing of certification |
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Section 438.606
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Program integrity requirements |
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Section 438.608
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Prohibited affiliations with individuals debarred by Federal agencies |
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Section 438.610
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Basis for imposition of sanctions |
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Section 438.700
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Types of intermediate sanctions |
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Section 438.702
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Amounts of civil money penalties |
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Section 438.704
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Special rules for temporary management |
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Section 438.706
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Termination of an MCO or PCCM contract |
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Section 438.708
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Due process: Notice of sanction and pre-termination hearing |
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Section 438.710
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Disenrollment during termination hearing process |
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Section 438.722
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Notice to CMS |
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Section 438.724
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State plan requirement |
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Section 438.726
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Sanction by CMS: Special rules for MCOs |
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Section 438.730
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Basic requirements |
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Section 438.802
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Primary care provider payment increases |
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Section 438.804
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Prior approval |
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Section 438.806
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Exclusion of entities |
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Section 438.808
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Expenditures for enrollment broker services |
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Section 438.810
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Costs under risk and nonrisk contracts |
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Section 438.812
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Basis and purpose |