[Code of Federal Regulations] [Title 42, Volume 2] [Revised as of October 1, 2007] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR403.200] [Page 43-44] TITLE 42--PUBLIC HEALTH HUMAN SERVICES PART 403_SPECIAL PROGRAMS AND PROJECTS--Table of Contents Subpart B_Medicare Supplemental Policies Sec. 403.200 Basis and scope. Subpart A [Reserved] Subpart B_Medicare Supplemental Policies Sec. 403.200 Basis and scope. General Provisions 403.201 State regulation of insurance policies. 403.205 Medicare supplemental policy. 403.206 General standards for Medicare supplemental policies. 403.210 NAIC model standards. 403.215 Loss ratio standards. State Regulatory Programs 403.220 Supplemental Health Insurance Panel. 403.222 State with an approved regulatory program. Voluntary Certification Program: General Provisions 403.231 Emblem. 403.232 Requirements and procedures for obtaining certification. 403.235 Review and certification of policies. 403.239 Submittal of material to retain certification. 403.245 Loss of certification. 403.248 Administrative review of CMS determinations. Voluntary Certification Program: Loss Ratio Provisions 403.250 Loss ratio calculations: General provisions. 403.251 Loss ratio date and time frame provisions. 403.253 Calculation of benefits. 403.254 Calculation of premiums. 403.256 Loss ratio supporting data. 403.258 Statement of actuarial opinion. Subpart C_Recognition of State Reimbursement Control Systems 403.300 Basis and purpose. 403.302 Definitions. 403.304 Minimum requirements for State systems--discretionary approval. 403.306 Additional requirements for State systems--mandatory approval. 403.308 State systems under demonstration projects--mandatory approval. 403.310 Reduction in payments. 403.312 Submittal of application. 403.314 Evaluation of State systems. 403.316 Reconsideration of certain denied applications. 403.318 Approval of State systems. 403.320 CMS review and monitoring of State systems. 403.321 State systems for hospital outpatient services. 403.322 Termination of agreements for Medicare recognition of State systems. Subpart D [Reserved] Subpart E_Beneficiary Counseling and Assistance Grants 403.500 Basis, scope, and definition. 403.501 Eligibility for grants. 403.502 Availability of grants. 403.504 Number and size of grants. 403.508 Limitations. 403.510 Reporting requirements. 403.512 Administration. Subpart F [Reserved] Subpart G_Religious Nonmedical Health Care Institutions_Benefits, Conditions of Participation, and Payment 403.700 Basis and purpose. 403.702 Definitions and terms. 403.720 Conditions for coverage. 403.724 Valid election requirements. 403.730 Condition of participation: Patient rights. 403.732 Condition of participation: Quality assessment and performance improvement. 403.734 Condition of participation: Food services. 403.736 Condition of participation: Discharge planning. 403.738 Condition of participation: Administration. 403.740 Condition of participation: Staffing. 403.742 Condition of participation: Physical environment. 403.744 Condition of participation: Life safety from fire. 403.746 Condition of participation: Utilization review. 403.750 Estimate of expenditures and adjustments. 403.752 Payment provisions. 403.754 Monitoring expenditure level. 403.756 Sunset provision. [[Page 44]] 403.764 Basis and purpose of religious nonmedical health care institutions providing home service. 403.766 Requirements for coverage and payment of RNHCI home services. 403.768 Excluded services. 403.770 Payments for home services. Subpart H_Medicare Prescription Drug Discount Card and Transitional Assistance Program 403.800 Basis and scope. 403.802 Definitions. 403.804 General rules for solicitation, application and Medicare endorsement period. 403.806 Sponsor requirements for eligibility for endorsement. 403.808 Use of transitional assistance funds. 403.810 Eligibility and reconsiderations. 403.811 Enrollment, disenrollment, and associated endorsed sponsor requirements. 403.812 HIPAA privacy, security, administrative data standards, and national identifiers. 403.813 Marketing limitations and record retention requirements. 403.814 Special rules concerning Part C organizations and Medicare cost plans and their enrollees. 403.815 Special rules concerning States. 403.816 Special rules concerning long-term care and I/T/U pharmacies. 403.817 Special rules concerning the territories. 403.820 Sanctions, penalties, and termination. 403.822 Reimbursement of transitional assistance and associated sponsor requirements. Authority: 42 U.S.C. 1395b-3 and Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). Subpart A [Reserved] Source: 47 FR 32400, July 26, 1982, unless otherwise noted. (a) Provisions of the legislation. This subpart implements, in part, section 1882 of the Social Security Act. The intent of that section is to enable Medicare beneficiaries to identify Medicare supplemental policies that do not duplicate Medicare, and that provide adequate, fairly priced protection against expenses not covered by Medicare. The legislation establishes certain standards for Medicare supplemental policies and provides two methods for informing Medicare beneficiaries which policies meet those standards: (1) Through a State approved program, that is, a program that a Supplemental Health Insurance Panel determines to meet certain minimum requirements for the regulation of Medicare supplemental policies; and (2) In a State without an approved program, through certification by the Secretary of policies voluntarily submitted by insuring organizations for review against the standards. (b) Scope of subpart. This subpart sets forth the standards and procedures CMS will use to implement the voluntary certification program. General Provisions