42 CFR Part 455 - PART 455—PROGRAM INTEGRITY: MEDICAID

The following state regulations pages link to this page.

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Alabama

• Ala. Admin. Code r. 560-X-33-.01 - 560-X-33-.01 - General

• Ala. Admin. Code r. 560-X-33-.02 - 560-X-33-.02 - Purpose

• Ala. Admin. Code r. 560-X-33-.03 - 560-X-33-.03 - Reserved

• Ala. Admin. Code r. 560-X-33-.04 - 560-X-33-.04 - Recoupments

• Ala. Admin. Code r. 560-X-33-.05 - 560-X-33-.05 - Estate Recovery

• Ala. Admin. Code r. 560-X-33-.07 - 560-X-33-.07 - Appeals

• Ala. Admin. Code r. 560-X-4-.01 - 560-X-4-.01 - General

Arizona

• Ariz. Admin. Code R9-22-712.90 - R9-22-712.90 - Reimbursement of Hospital-based Freestanding Emergency Departments

Hawaii

• Haw. Code R. §11-88.1-30 - §11-88.1-30 - Corrective action

Idaho

• Idaho Admin. Code r. 16.03.09.405 - 405 - INPATIENT HOSPITAL SERVICES: PROVIDER REIMBURSEMENT.

• Idaho Admin. Code r. 16.03.25.200 - 200 - EHR: FEDERALLY INITIATED PROGRAM.

Iowa

• Iowa Admin. Code r. 441-78.34 - 441.78.34 - HCBS ill and handicapped waiver services.

• Iowa Admin. Code r. 441-79.14 - 441.79.14 - Provider enrollment.

Louisiana

• La. Admin. Code tit. 50, Part I, §1501 - §1501 - General Provisions

• La. Admin. Code tit. 50, Part II, §10111 - §10111 - Introduction

Maine

• 10 144 Me. Code R. Ch. 101 § Ch. II - Section 113 - Ch. II - Section 113 - Non-Emergency Transportation (NET) Services

Maryland

• COMAR 10.09.18.03 - 10.09.18.03 - Conditions for Participation.

• COMAR 10.67.07.01 - 10.67.07.01 - Requirements to Detect and Prevent Fraud, Waste, and Abuse.

Mississippi

• Miss. Admin. Code. 23-200-4.1 - Rule 4.1 - Definitions

• Miss. Admin. Code. 23-200-4.2 - Rule 4.2 - Conditions of Participation

• Miss. Admin. Code. 23-203-7.1 - Rule 7.1 - Provider Enrollment

• Miss. Admin. Code. 23-203-8.1 - Rule 8.1 - Physician Assistant Enrollment Requirements

• Miss. Admin. Code. 23-208-3.3 - Rule 3.3 - Provider Enrollment

• Miss. Admin. Code. 23-211-1.1 - Rule 1.1 - Provider Enrollment Requirements

• Miss. Admin. Code. 23-212-1.1 - Rule 1.1 - Provider Enrollment Requirements

• Miss. Admin. Code. 23-215-1.2 - Rule 1.2 - Provider Enrollment Requirements

• Miss. Admin. Code. 23-216-1.1 - Rule 1.1 - Provider Enrollment Requirements

• Miss. Admin. Code. 23-305-1.1 - Rule 1.1 - Definitions

• Miss. Admin. Code. 23-305-1.2 - Rule 1.2 - Fraud, Waste, and Abuse

• Miss. Admin. Code. 23-305-1.3 - Rule 1.3 - Overpayments

• Miss. Admin. Code. 23-305-1.4 - Rule 1.4 - Corrective Action Plan (CAP)

Missouri

• 13 CSR 65-2.010 - 13 CSR 65-2.010 - Definitions

• 13 CSR 65-2.020 - 13 CSR 65-2.020 - Provider Enrollment and Application

• 13 CSR 65-2.030 - 13 CSR 65-2.030 - Denial or Limitations of Applying Provider

Montana

• Mont. Admin. R. 37.86.2925 - 37.86.2925 - INPATIENT HOSPITAL REIMBURSEMENT, DISPROPORTIONATE SHARE HOSPITAL (DSH) PAYMENTS

Nebraska

• 175 Neb. Admin. Code. Ch. 17 § 008 - 17-008 - DENIAL, REFUSAL TO RENEW, AND DISCIPLINARY ACTION

• 465 Neb. Admin. Code. Ch. 2 § 007 - 2-007 - Fraud and Abuse and Intentional Program Violations

• 471 Neb. Admin. Code. Ch. 2 § 001 - 2-001 - Provider Eligibility

New Hampshire

• N.H. Code Admin. R. He-C 5001.01 - He-C 5001.01 - Definitions

• N.H. Code Admin. R. He-W 594 - APPENDIX B - APPENDIX B -

North Carolina

• 10A NCAC 22F .0102 - 10A NCAC 22F .0102 - ORGANIZATION

• 10A NCAC 22F .0104 - 10A NCAC 22F .0104 - PREVENTION

• 10A NCAC 22F .0105 - 10A NCAC 22F .0105 - REPEALED - DETECTION

• 10A NCAC 22F .0106 - 10A NCAC 22F .0106 - CONFIDENTIALITY

• 10A NCAC 22F .0107 - 10A NCAC 22F .0107 - RECORD RETENTION

• 10A NCAC 22F .0201 - 10A NCAC 22F .0201 - REPEALED - DEFINITION OF PROVIDER FRAUD

• 10A NCAC 22F .0202 - 10A NCAC 22F .0202 - INVESTIGATION

• 10A NCAC 22F .0402 - 10A NCAC 22F .0402 - RECONSIDERATION REVIEW FOR PROGRAM ABUSE

• 10A NCAC 22F .0501-.0505 - 10A NCAC 22F .0501-.0505 - EXPIRED

• 10A NCAC 22F .0506-.0510 - 10A NCAC 22F .0506-.0510 - EXPIRED

• 10A NCAC 22F .0601 - 10A NCAC 22F .0601 - RECOUPMENT

• 10A NCAC 22F .0602 - 10A NCAC 22F .0602 - ADMINISTRATIVE ACTIONS

• 10A NCAC 22F .0603 - 10A NCAC 22F .0603 - PROVIDER LOCK-OUT

• 10A NCAC 22F .0605 - 10A NCAC 22F .0605 - REPEALED - TERMINATION

• 10A NCAC 22F .0606 - 10A NCAC 22F .0606 - REPEALED - TECHNIQUE FOR PROJECTING MEDICAID OVERPAYMENTS

• 10A NCAC 22F .0701 - 10A NCAC 22F .0701 - DEFINITION OF FRAUD AND ABUSE

• 10A NCAC 22F .0702 - 10A NCAC 22F .0702 - GENERAL

• 10A NCAC 22F .0703 - 10A NCAC 22F .0703 - EXPIRED - WARNING NOTIFICATION

• 10A NCAC 22F .0704 - 10A NCAC 22F .0704 - RECIPIENT MANAGEMENT LOCK-IN SYSTEM

• 10A NCAC 22F .0705 - 10A NCAC 22F .0705 - EXPIRED - OVERUTILIZATION SURVEILLANCE (SUR INDICATOR)

• 10A NCAC 22F .0706 - 10A NCAC 22F .0706 - RECOUPMENT OF RECIPIENT OVERPAYMENTS

• 10A NCAC 22F .0707 - 10A NCAC 22F .0707 - EXPIRED - REPORTS AND REVIEWS

• 10A NCAC 22N .0102 - 10A NCAC 22N .0102 - SIGNED AGREEMENTS

North Dakota

• N.D. Admin. Code 75-02-02-11 - 75-02-02-11 - Coordinated services.

• N.D. Admin. Code 75-02-02-12 - 75-02-02-12 - Limitations on emergency room services.

Ohio

• Ohio Admin. Code 5160-1-17.6 - 5160-1-17.6 - Termination and denial of provider agreement.

• Ohio Admin. Code 5160-15-14 - 5160-15-14 - Transportation: non-emergency services through a CDJFS: program integrity provisions.

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

Oklahoma

• Okla Admin. Code § 317:30-3-19.4 - Section 317:30-3-19.4 - Application fee, provider screening, and applicants subject to a fingerprint-based criminal background check

Oregon

• OR Admin. Rule 407-120-0360 - 407-120-0360 - Consequences of Non-Compliance and Provider Sanctions

• OR Admin. Rule 410-120-1460 - 410-120-1460 - Type and Conditions of Sanction

Virginia

• 12 Va. Admin. Code § 30-10-520 - 12VAC30-10-520 - Required provider agreement.

• 12 Va. Admin. Code § 30-50-130 - 12VAC30-50-130 - Nursing facility services, EPSDT, including school health services, and family planning.

Washington

• Wash. Admin. Code § 182-502-0010 - 182-502-0010 - When the medicaid agency enrolls.

• Wash. Admin. Code § 182-543-2000 - 182-543-2000 - Eligible providers and provider requirements.

• Wash. Admin. Code § 182-550-4900 - 182-550-4900 - Disproportionate share hospital (DSH) payments—General provisions.

• Wash. Admin. Code § 182-550-4940 - 182-550-4940 - Disproportionate share hospital independent audit findings and recoupment process.