42Public Health32000-10-012000-10-01falseTable Of ContentsPublic HealthSTATE ORGANIZATION AND GENERAL ADMINISTRATIONSec.431.1Purpose.Subpart A—Single State Agency431.10Single State agency.431.11Organization for administration.431.12Medical care advisory committee.431.15Methods of administration.431.16Reports.431.17Maintenance of records.431.18Availability of agency program manuals.431.20Advance directives.Subpart B—General Administrative Requirements431.40Basis and scope.431.50Statewide operation.431.51Free choice of providers.431.52Payments for services furnished out of State.431.53Assurance of transportation.431.54Exceptions to certain State plan requirements.431.55Waiver of other Medicaid requirements.431.56Special waiver provisions applicable to American Samoa and the Northern Mariana Islands.431.57Waiver of cost-sharing requirements.Subpart C—Administrative Requirements: Provider Relations431.105Consultation to medical facilities.431.107Required provider agreement.431.108Effective date of provider agreements.431.110Participation by Indian Health Service facilities.431.115Disclosure of survey information and provider or contractor evaluation.431.120State requirements with respect to nursing facilities.Subpart D—Appeals Process for NFs and ICFs/MR431.151Scope and applicability.431.152State plan requirements.431.153Evidentiary hearing.431.154Informal reconsideration for ICFs/MR.Subpart E—Fair Hearings for Applicants and RecipientsGeneral Provisions431.200Basis and purpose.431.201Definitions.431.202State plan requirements.431.205Provision of hearing system.431.206Informing applicants and recipients.Notice431.210Content of notice.431.211Advance notice.431.213Exceptions from advance notice.431.214Notice in cases of probable fraud.Right to Hearing431.220When a hearing is required.431.221Request for hearing.431.222Group hearings.431.223Denial or dismissal of request for a hearing.Procedures431.230Maintaining services.431.231Reinstatement of services.431.232Adverse decision of local evidentiary hearing.431.233State agency hearing after adverse decision of local evidentiary hearing.431.240Conducting the hearing.431.241Matters to be considered at the hearing.431.242Procedural rights of the applicant or recipient.431.243Parties in cases involving an eligibility determination.431.244Hearing decisions.431.245Notifying the applicant or recipient of a State agency decision.431.246Corrective action.Federal Financial Participation431.250Federal financial participation.Subpart F—Safeguarding Information on Applicants and Recipients431.300Basis and purpose.431.301State plan requirements.431.302Purposes directly related to State plan administration.431.303State authority for safeguarding information.431.304Publicizing safeguarding requirements.431.305Types of information to be safeguarded.431.306Release of information.431.307Distribution of information materials.Subparts G—L [Reserved]Subpart M—Relations With Other Agencies431.610Relations with standard-setting and survey agencies.431.615Relations with State health and vocational rehabilitation agencies and title V grantees.431.620Agreement with State mental health authority or mental institutions.431.621State requirements with respect to nursing facilities.431.625Coordination of Medicaid with Medicare part B.431.630Coordination of Medicaid with PROs.431.635Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children (WIC).Subpart N—State Programs for Licensing Nursing Home Administrators431.700Basis and purpose.431.701Definitions.431.702State plan requirement.431.703Licensing requirement.431.704Nursing homes designated by other terms.431.705Licensing authority.431.706Composition of licensing board.431.707Standards.431.708Procedures for applying standards.431.709Issuance and revocation of license.431.710Provisional licenses.431.711Compliance with standards.431.712Failure to comply with standards.431.713Continuing study and investigation.431.714Waivers.431.715Federal financial participation.Subpart O [Reserved]Subpart P—Quality ControlGeneral Provisions431.800Scope of subpart.431.802Basis.431.804Definitions.431.806State plan requirements.431.808Protection of recipient rights.Medicaid Eligibility Quality Control (MEQC) Program431.810Basic elements of the Medicaid eligibility quality control (MEQC) program.431.812Review procedures.431.814Sampling plan and procedures.431.816Case review completion deadlines and submittal of reports.431.818Access to records: MEQC program.431.820Corrective action under the MEQC program.431.822Resolution of differences in State and Federal case eligibility or payment findings.Medicaid Quality Control (MQC) Claims Processing Assessment System431.830Basic elements of the Medicaid quality control (MQC) claims processing assessment system.431.832Reporting requirements for claims processing assessment systems.431.834Access to records: Claims processing assessment systems.431.836Corrective action under the MQC claims processing assessment systems.Federal Financial Participation431.861-431.864[Reserved]431.865Disallowance of Federal financial participation for erroneous State payments (for annual assessment periods ending after July 1, 1990).Authority:
Sec. 1102 of the Social Security Act, (42 U.S.C. 1302).