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 C—Grants; Reviews and Audits; Withholding for Failure To Comply; Deferral and Disallowance of Claims; Reduction of Federal Medicaid Payments

42 C.F.R. § 430.32

Program reviews

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(a) Review of State and local administration. In order to determine whether the State is complying with the Federal requirements and the provisions of its plan, CMS reviews State and local administration through analysis of the State's policies and procedures, on-site review of selected aspects of agency operation, and examination of samples of individual case records.

(b) Quality control program. The State itself is required to carry out a continuing quality control program as set forth in part 431, subpart P, of this chapter.

(c) Action on review findings. If Federal or State reviews reveal serious problems with respect to compliance with any Federal requirement, the State must correct its practice accordingly.

Notes of Decisions
Cited in 2 cases (1 in the last 5 years), 2018–2023 · leading case: Tennessee v. U.S. Dep't of State, 329 F. Supp. 3d 597 (W.D. Tenn. 2018).
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Tennessee v. U.S. Dep't of State, 329 F. Supp. 3d 597 (W.D. Tenn. 2018). “42 C.F.R. §§ 430.32 , 430.35. If these efforts are unsuccessful, CMS initiates a formal compliance action by letter to the state which sets forth the finding of non-compliance, provides notice that some or all federal funding will be withheld absent compliance, and explains that…”
Arizona Health Care Cost Containment Sys. v. Centers For Medicare & Medicaid Servs., No. 2:21-cv-00952 (D. Ariz. July 20, 2023). “See generally 42 C.F.R. §§ 430.32 (a), 430.33(a)(2). If CMS determines that 9 Medicaid has overpaid the state, CMS issues a notice of disallowance.”
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