[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: 42CFR438.66]



[Page 221]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 438_MANAGED CARE--Table of Contents

 

                    Subpart B_State Responsibilities

 

Sec.  438.66  Monitoring procedures.



    The State agency must have in effect procedures for monitoring the 

MCO's, PIHP's, or PAHP's operations, including, at a minimum, operations 

related to the following:

    (a) Recipient enrollment and disenrollment.

    (b) Processing of grievances and appeals.

    (c) Violations subject to intermediate sanctions, as set forth in 

subpart I of this part.

    (d) Violations of the conditions for FFP, as set forth in subpart J 

of this part.

    (e) All other provisions of the contract, as appropriate.