[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: 42CFR433.119]



[Page 93]

 

                         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.  433.119  Conditions for reapproval; notice of decision.



    (a) CMS will review at least once every three years each system 

operation initially approved under Sec.  433.114 and reapprove it for 

FFP at 75 percent of expenditures if the following conditions are met:

    (1) The system meets the conditions of Sec.  433.112(b) (1), (3), 

(4), and (7) through (9).

    (2) The system meets the conditions of Sec.  433.116 (d) through 

(h).

    (3) The system meets the performance standards for reapproval and 

the system requirements in part 11 of the State Medicaid Manual as 

periodically amended.

    (4) Automated eligibility determination systems approved or 

operating on or before November 13, 1989, will not qualify for FFP at 75 

percent of expenditures after November 13, 1989.

    (b) CMS may review an entire system operation or focus its review on 

parts of the operation. However, at a minimum, CMS will review 

standards, system requirements and other conditions of reapproval that 

have demonstrated weakness in a previous review or reviews.

    (c) CMS will issue to each Medicaid agency, by the end of the first 

quarter after the review period, a written notice informing the agency 

whether its system is reapproved or disapproved. If the system is 

disapproved, the notice will also include--

    (1) CMS's decision to reduce FFP for system operations, and the 

percentage to which it is reduced, beginning with the next calender 

quarter;

    (2) The findings of fact upon which the determination was made; and

    (3) A statement that State claims in excess of the reduced FFP rate 

will be disallowed and that any such disallowance will be appealable to 

the Departmental Appeals Board.



[54 FR 41973, Oct. 13, 1989; 55 FR 1820, Jan. 19, 1990]