[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: 42CFR456.2]



[Page 342]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 456_UTILIZATION CONTROL--Table of Contents

 

                      Subpart A_General Provisions

 

Sec.  456.2  State plan requirements.



    (a) A State plan must provide that the requirements of this part are 

met.

    (b) These requirements may be met by the agency by:

    (1) Assuming direct responsibility for assuring that the 

requirements of this part are met; or

    (2) Deeming of medical and utilization review requirements if the 

agency contracts with a QIO to perform that review, which in the case of 

inpatient acute care review will also serve as the initial determination 

for QIO medical necessity and appropriateness review for patients who 

are dually entitled to benefits under Medicare and Medicaid.

    (c) In accordance with Sec.  431.15 of this subchapter, FFP will be 

available for expenses incurred in meeting the requirements of this 

part.



[46 FR 48566, Oct. 1, 1981, as amended at 50 FR 15327, Apr. 17, 1985; 51 

FR 43198, Dec. 1, 1986]