[Code of Federal Regulations] [Title 42, Volume 3] [Revised as of October 1, 2004] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR431.1] [Page 19-21] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PART 431_STATE ORGANIZATION AND GENERAL ADMINISTRATION--Table of Contents Sec. 431.1 Purpose. Sec. 431.1 Purpose. Subpart A_Single State Agency 431.10 Single State agency. 431.11 Organization for administration. 431.12 Medical care advisory committee. 431.15 Methods of administration. 431.16 Reports. 431.17 Maintenance of records. 431.18 Availability of agency program manuals. 431.20 Advance directives. Subpart B_General Administrative Requirements 431.40 Basis and scope. 431.50 Statewide operation. 431.51 Free choice of providers. 431.52 Payments for services furnished out of State. 431.53 Assurance of transportation. 431.54 Exceptions to certain State plan requirements. 431.55 Waiver of other Medicaid requirements. 431.56 Special waiver provisions applicable to American Samoa and the Northern Mariana Islands. 431.57 Waiver of cost-sharing requirements. Subpart C_Administrative Requirements: Provider Relations 431.105 Consultation to medical facilities. 431.107 Required provider agreement. 431.108 Effective date of provider agreements. 431.110 Participation by Indian Health Service facilities. 431.115 Disclosure of survey information and provider or contractor evaluation. 431.120 State requirements with respect to nursing facilities. Subpart D_Appeals Process for NFs and ICFs/MR 431.151 Scope and applicability. 431.152 State plan requirements. 431.153 Evidentiary hearing. [[Page 20]] 431.154 Informal reconsideration for ICFs/MR. Subpart E_Fair Hearings for Applicants and Recipients General Provisions 431.200 Basis and purpose. 431.201 Definitions. 431.202 State plan requirements. 431.205 Provision of hearing system. 431.206 Informing applicants and recipients. Notice 431.210 Content of notice. 431.211 Advance notice. 431.213 Exceptions from advance notice. 431.214 Notice in cases of probable fraud. Right to Hearing 431.220 When a hearing is required. 431.221 Request for hearing. 431.222 Group hearings. 431.223 Denial or dismissal of request for a hearing. Procedures 431.230 Maintaining services. 431.231 Reinstatement of services. 431.232 Adverse decision of local evidentiary hearing. 431.233 State agency hearing after adverse decision of local evidentiary hearing. 431.240 Conducting the hearing. 431.241 Matters to be considered at the hearing. 431.242 Procedural rights of the applicant or recipient. 431.243 Parties in cases involving an eligibility determination. 431.244 Hearing decisions. 431.245 Notifying the applicant or recipient of a State agency decision. 431.246 Corrective action. Federal Financial Participation 431.250 Federal financial participation. Subpart F_Safeguarding Information on Applicants and Recipients 431.300 Basis and purpose. 431.301 State plan requirements. 431.302 Purposes directly related to State plan administration. 431.303 State authority for safeguarding information. 431.304 Publicizing safeguarding requirements. 431.305 Types of information to be safeguarded. 431.306 Release of information. 431.307 Distribution of information materials. Subparts G-L [Reserved] Subpart M_Relations With Other Agencies 431.610 Relations with standard-setting and survey agencies. 431.615 Relations with State health and vocational rehabilitation agencies and title V grantees. 431.620 Agreement with State mental health authority or mental institutions. 431.621 State requirements with respect to nursing facilities. 431.625 Coordination of Medicaid with Medicare part B. 431.630 Coordination of Medicaid with QIOs. 431.635 Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children (WIC). 431.636 Coordination of Medicaid with the State Children's Health Insurance Program (SCHIP). Subpart N_State Programs for Licensing Nursing Home Administrators 431.700 Basis and purpose. 431.701 Definitions. 431.702 State plan requirement. 431.703 Licensing requirement. 431.704 Nursing homes designated by other terms. 431.705 Licensing authority. 431.706 Composition of licensing board. 431.707 Standards. 431.708 Procedures for applying standards. 431.709 Issuance and revocation of license. 431.710 Provisional licenses. 431.711 Compliance with standards. 431.712 Failure to comply with standards. 431.713 Continuing study and investigation. 431.714 Waivers. 431.715 Federal financial participation. Subpart O [Reserved] Subpart P_Quality Control General Provisions 431.800 Scope of subpart. 431.802 Basis. 431.804 Definitions. 431.806 State plan requirements. 431.808 Protection of recipient rights. Medicaid Eligibility Quality Control (MEQC) Program 431.810 Basic elements of the Medicaid eligibility quality control (MEQC) program. 431.812 Review procedures. 431.814 Sampling plan and procedures. 431.816 Case review completion deadlines and submittal of reports. 431.818 Access to records: MEQC program. 431.820 Corrective action under the MEQC program. 431.822 Resolution of differences in State and Federal case eligibility or payment findings. [[Page 21]] Medicaid Quality Control (MQC) Claims Processing Assessment System 431.830 Basic elements of the Medicaid quality control (MQC) claims processing assessment system. 431.832 Reporting requirements for claims processing assessment systems. 431.834 Access to records: Claims processing assessment systems. 431.836 Corrective action under the MQC claims processing assessment systems. Federal Financial Participation 431.861-431.864 [Reserved] 431.865 Disallowance 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). Source: 43 FR 45188, Sept. 29, 1978, unless otherwise noted. This part establishes State plan requirements for the designation, organization, and general administrative activities of a State agency responsible for operating the State Medicaid program, directly or through supervision of local administering agencies.