[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR433.112]



[Page 91]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 433_STATE FISCAL ADMINISTRATION--Table of Contents

 

Subpart C_Mechanized Claims Processing and Information Retrieval Systems

 

Sec.  433.112  FFP for design, development, installation or enhancement 



of mechanized claims processing and information retrieval systems.



    (a) FFP is available at the 90 percent rate in State expenditures 

for the design, development, installation, or enhancement of a 

mechanized claims processing and information retrieval system only if 

the APD is approved by CMS prior to the State's expenditure of funds for 

these purposes.

    (b) CMS will approve the system described in the APD if the 

following conditions are met:

    (1) CMS determines the system is likely to provide more efficient, 

economical, and effective administration of the State plan.

    (2) The system meets the system requirements and performance 

standards in Part 11 of the State Medicaid Manual, as periodically 

amended.

    (3) The system is compatible with the claims processing and 

information retrieval systems used in the administration of Medicare for 

prompt eligibility verification and for processing claims for persons 

eligible for both programs.

    (4) The system supports the data requirements of quality improvement 

organizations established under Part B of title XI of the Act.

    (5) The State owns any software that is designed, developed, 

installed or improved with 90 percent FFP.

    (6) The Department has a royalty free, non-exclusive, and 

irrevocable license to reproduce, publish, or otherwise use and 

authorize others to use, for Federal Government purposes, software, 

modifications to software, and documentation that is designed, 

developed, installed or enhanced with 90 percent FFP.

    (7) The costs of the system are determined in accordance with 45 CFR 

74.171.

    (8) The Medicaid agency agrees in writing to use the system for the 

period of time specified in the advance planning document approved by 

CMS or for any shorter period of time that CMS determines justifies the 

Federal funds invested.

    (9) The agency agrees in writing that the information in the system 

will be safeguarded in accordance with subpart F, part 431 of this 

subchapter.

    (c) Eligibility determination systems are not part of mechanized 

claims processing and information retrieval systems and are not eligible 

for 75 percent FFP under this subpart. These systems are also not 

eligible for 90 percent FFP for any APD approved after November 13, 

1989.



[43 FR 45201, Sept. 29, 1978, as amended at 44 FR 17937, Mar. 23, 1979; 

45 FR 14213, Mar. 5, 1980; 50 FR 30846, July 30, 1985; 51 FR 45330, Dec. 

18, 1986; 54 FR 41973, Oct. 13, 1989; 55 FR 1820, Jan. 19, 1990; 55 FR 

4375, Feb. 7, 1990]