C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 430—GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS › Subpart B—State Plans

42 C.F.R. § 430.18

Administrative review of action on State plan material

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(a) Request for reconsideration. Any State dissatisfied with the Administrator's action on plan material under § 430.15 may, within 60 days after receipt of the notice provided under § 430.16(b), request that the Administrator reconsider the issue of whether the plan or plan amendment conforms to the requirements for approval.

(b) Notice and timing of hearing. (1) Within 30 days after receipt of the request, the Administrator notifies the State of the time and place of the hearing.

(2) The hearing takes place not less than 30 days nor more than 60 days after the date of the notice, unless the State and the Administrator agree in writing on an earlier or later date.

(c) Hearing procedures. The hearing procedures are set forth in subpart D of this part.

(d) Decision. A decision affirming, modifying, or reversing the Administrator's original determination is made in accordance with § 430.102.

(e) Effect of hearing decision. (1) Denial of Federal funds, if required by the Administrator's original determination, will not be delayed pending a hearing decision.

(2) However, if the Administrator determines that his or her original decision was incorrect, CMS pays the State a lump sum equal to any funds incorrectly denied.

Notes of Decisions
Cited in 14 cases (1 in the last 5 years), 1990–2021 · leading case: Planned Parenthood of Indiana, Inc. v. Comm'r of Indiana State Dep't of Health, 699 F.3d 962 (7th Cir. 2012).
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Planned Parenthood of Indiana, Inc. v. Comm'r of Indiana State Dep't of Health, 699 F.3d 962 (7th Cir. 2012). “§ 1316 (a)(2); 42 C.F.R. § 430.18 . This initiated an administrative appeal process that included a hearing, see 42 C.”
State of West Virginia v. Tommy G. Thompson, 475 F.3d 204 (4th Cir. 2007). “3d at 939; see also 42 C.F.R. § 430.18 (2005). Recognizing the mechanisms for evaluation of amendments at the agency level, “[w]e take care not lightly to disrupt the informed judgments of those who must labor daily in the minefield of often arcane policy, especially given the…”
Indep. Acceptance Co. v. California, 204 F.3d 1247 (9th Cir. 2000). · cites it 3× “Pursuant to 42 C.F.R. § 430.18 , the State timely petitioned for reconsideration of the Secretary’s decision to disapprove the amendment.”
Louisiana Dep't of Health & Hospitals v. Ctr. for Medicare & Medicaid Servs., 346 F.3d 571 (5th Cir. 2003). “See 42 C.F.R. § 430.18 (providing for review of CMS disapprovals).”
State of Louisiana v. United States Dep't of Health & Human Servs., 905 F.2d 877 (5th Cir. 1990). “§ 1316 (a)(2), (c); 42 C.F.R. §§ 430.18 , 430.60 et seq. One federal requirement is that the state plan “provide such methods and procedures relating to the utilization of, and payment for, care and services available under the plan .”
Planned Parenthood of Indiana, Inc. v. Comm'r of the Indiana State Dep't of Health, 794 F. Supp. 2d 892 (S.D. Ind. 2011). “See 42 C.F.R. § 430.18 . While this fact perhaps reduces the deference owed HHS’ decision, it does not extinguish it altogether, particularly given the early procedural posture of this case.”
North Carolina v. United States Dep't of Health & Human Servs., 999 F.2d 767 (4th Cir. 1993). “§ 1316 (a)(2), 42 C.F.R. § 430.18 , North Carolina petitioned HCFA to reconsider its denial of the effective date of April 1, 1990 for SPA-90-14.”
Planned Parenthood v. Comm'r OF IND., 794 F. Supp. 2d 892 (S.D. Ind. 2011). “See 42 C.F.R. § 430.18 . While this fact perhaps reduces the deference owed HHS' decision, it does not extinguish it altogether, particularly given the early procedural posture of this case.”
Louisiana Dep't of Health v. HHS, No. 20-60213 (5th Cir. Apr. 5, 2021). “§ 1316 (a)(2), (c); 42 C.F.R. §§ 430.18 , 430.60. The regulations at issue in 2012, when Louisiana sought CMS’ approval for the state plan amendment at issue in this case, referred to two components for reimbursements paid to pharmacies for prescription drugs: a drug’s…”
Planned Parenthood o v. Commissione, No. 11-2464 (7th Cir. Oct. 23, 2012). “§ 1316 (a)(2); 42 C.F.R. § 430.18 . This initiated an administrative appeal process that included a hearing, see 42 C.”
Cmty. Pharmacies of Indiana, Inc. v. Indiana Fam. & Soc. Servs. Admin. & Its Subdivision, 816 F. Supp. 2d 570 (S.D. Ind. 2011). “” Obviously, this regulation presupposes that a state will go ahead and implement the unapproved plan amendment.”
Cmty. Pharmacies of Indiana, Inc. v. Indiana Fam. & Soc. Servs. Admin., 823 F. Supp. 2d 876 (S.D. Ind. 2011). “Specifically, 42 C.F.R. § 430.18 (e)(2) explains that if the Medicaid administrator reviews CMS’s initial decision and determines that it was incorrect, then “CMS pays the State a lump sum equal to any funds incorrectly denied.”
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