42 CFR Part 438 - PART 438—MANAGED CARE

The following state regulations pages link to this page.

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Alabama

• Ala. Admin. Code r. 560-X-37-.09 - 560-X-37-.09 - Attribution Under The Alabama Coordinated Health Network Program

• Ala. Admin. Code r. 560-X-62-.13 - 560-X-62-.13 - Quality Assurance Committee

• Ala. Admin. Code r. 560-X-62-.14 - 560-X-62-.14 - Quality Assurance Process

• Ala. Admin. Code r. 560-X-62-.15 - 560-X-62-.15 - Right To Terminate Certificates Of Probationary And Fully Certified Regional Care Organizations

• Ala. Admin. Code r. 560-X-62-.17 - 560-X-62-.17 - Financial Reporting And Audit Requirements

• Ala. Admin. Code r. 560-X-62-.18 - 560-X-62-.18 - Hazardous Financial Condition And Insolvency

• Ala. Admin. Code r. 560-X-62-.19 - 560-X-62-.19 - Requirements For Full Certification Of Regional Care Organizations

• Ala. Admin. Code r. 560-X-62-.21 - 560-X-62-.21 - Information Requirements For Enrollees And Potential Enrollees

• Ala. Admin. Code r. 560-X-62-.23 - 560-X-62-.23 - Grievances And Appeals Of Medicaid Enrollees In Regional Care Organizations And Alternate Care Providers

• Ala. Admin. Code r. 560-X-64-.05 - 560-X-64-.05 - ICN Quality Assurance Committee

• Ala. Admin. Code r. 560-X-64-.07 - 560-X-64-.07 - Service Delivery Network Requirements For Integrated Care Networks

• Ala. Admin. Code r. 560-X-64-.10 - 560-X-64-.10 - Financial Reporting And Audit Requirements

• Ala. Admin. Code r. 560-X-64-.11 - 560-X-64-.11 - Hazardous Financial Condition And Insolvency

• Ala. Admin. Code r. 560-X-64-.16 - 560-X-64-.16 - ICN Covered Population

• Ala. Admin. Code r. 560-X-64-.17 - 560-X-64-.17 - ICN Covered Services

• Ala. Admin. Code r. 560-X-64-.18 - 560-X-64-.18 - Sanctions

California

• 9 CCR Sec. 1850.210 - § 1850.210 - Provision of Notice of Action.

Idaho

• Idaho Admin. Code r. 16.05.03.302 - 302 - DIVISION OF MEDICAID: APPEALS PROCESS FOR MEDICAID PARTICIPANTS.

Kansas

• Kan. Admin. Regs. § 129-14-3 - 129-14-3 - Providers

Massachusetts

• 130 Mass. Code Regs. 450.117 - 450.117 - Managed Care

North Carolina

• 10A NCAC 22G .0504 - 10A NCAC 22G .0504 - HEALTH MAINTENANCE ORGANIZATIONS AND PREPAID HEALTH PLANS

North Dakota

• N.D. Admin. Code 75-02-05-03 - 75-02-05-03 - Definitions.

Ohio

• Ohio Admin. Code 5160-26-01 - 5160-26-01 - Managed health care programs: definitions.

• Ohio Admin. Code 5160-26-10 - 5160-26-10 - Managed health care programs: sanctions and provider agreement actions.

Oregon

• OR Admin. Rule 410-120-0000 - 410-120-0000 - Acronyms and Definitions

• OR Admin. Rule 410-141-3505 - 410-141-3505 - Use of Subcontractors

• OR Admin. Rule 410-141-3705 - 410-141-3705 - Criteria for CCOs

• OR Admin. Rule 410-141-3820 - 410-141-3820 - Covered Services

• OR Admin. Rule 410-141-5280 - 410-141-5280 - CCO ACQUISITIONS AND MERGERS: Determination Concerning Proposed Activity, Time For Decision, Grounds For Refusal

• OR Admin. Rule 410-165-0100 - 410-165-0100 - Participation and Incentive Payments

Tennessee

• TN Rules and Regs. 1200-13-13-.01 - 1200-13-13-.01 - DEFINITIONS

• TN Rules and Regs. 1200-13-13-.10 - 1200-13-13-.10 - EXCLUSIONS

• TN Rules and Regs. 1200-13-13-.11 - 1200-13-13-.11 - APPEAL OF ADVERSE BENEFIT DETERMINATIONS

• TN Rules and Regs. 1200-13-13-.12 - 1200-13-13-.12 - OTHER APPEALS BY TENNCARE APPLICANTS AND ENROLLEES

• TN Rules and Regs. 1200-13-14-.01 - 1200-13-14-.01 - DEFINITIONS

• TN Rules and Regs. 1200-13-14-.10 - 1200-13-14-.10 - EXCLUSIONS

• TN Rules and Regs. 1200-13-14-.11 - 1200-13-14-.11 - APPEAL OF ADVERSE BENEFIT DETERMINATIONS

• TN Rules and Regs. 1200-13-14-.12 - 1200-13-14-.12 - OTHER APPEALS BY TENNCARE APPLICANTS AND ENROLLEES

Vermont

• Vt. Code R. 13 110 002 - 13 110 002 - ATTENDANT SERVICES PROGRAM REGULATIONS

• Vt. Code R. 13 174 007 - 13 174 007 - SPECIALIZED SERVICES AND PROGRAMS

Virginia

• 12 Va. Admin. Code § 30-110-35 - 12VAC30-110-35 - Expedited appeals.

• 12 Va. Admin. Code § 30-120-400 - 12VAC30-120-400 - Quality control and utilization review.

• 12 Va. Admin. Code § 30-120-420 - 12VAC30-120-420 - Member grievances and appeals.

• 12 Va. Admin. Code § 30-121-10 - 12VAC30-121-10 - Commonwealth Coordinated Care program authority.

• 12 Va. Admin. Code § 30-121-190 - 12VAC30-121-190 - State fair hearing process.

• 12 Va. Admin. Code § 30-121-70 - 12VAC30-121-70 - Covered services.

• 12 Va. Admin. Code § 30-130-800 - 12VAC30-130-800 - Definitions.

• 12 Va. Admin. Code § 30-50-600 - 12VAC30-50-600 - Section 1932 Medicare-Medicaid eligible individuals.

Washington

• Wash. Admin. Code § 182-538-040 - 182-538-040 - Introduction.

• Wash. Admin. Code § 182-538-050 - 182-538-050 - Definitions.

• Wash. Admin. Code § 182-538-110 - 182-538-110 - The grievance and appeal system and agency administrative hearing for managed care organization (MCO) enrollees.

• Wash. Admin. Code § 182-538-140 - 182-538-140 - Quality of care.

• Wash. Admin. Code § 182-538B-110 - 182-538B-110 - Grievance and appeal system and agency administrative hearing.

Wyoming

• Health, Department of, Kid Care CHIP, Ch. 5 § 1 - Section 1 - Authority.