C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION › Subpart A—Single State Agency

42 C.F.R. § 431.18

Availability of agency program manuals

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(a) Basis and purpose. This section, based on section 1902(a)(4) of the Act, prescribes State plan requirements for facilitating access to Medicaid rules and policies by individuals outside the State Medicaid agency.

(b) State plan requirements. A State plan must provide that the Medicaid agency meets the requirements of paragraphs (c) through (g) of this section.

(c) Availability in agency offices. (1) The agency must maintain, in all its offices, copies of its current rules and policies that affect the public, including those that govern eligibility, provision of medical assistance, covered services, and beneficiary rights and responsibilities.

(2) These documents must be available upon request for review, study, and reproduction by individuals during regular working hours of the agency.

(d) Availability through other entities. The agency must provide copies of its current rules and policies to—

(1) Public and university libraries;

(2) The local or district offices of the Bureau of Indian Affairs;

(3) Welfare and legal services offices; and

(4) Other entities that—

(i) Request the material in order to make it accessible to the public;

(ii) Are centrally located and accessible to a substantial number of the beneficiary population they serve; and

(iii) Agree to accept responsibility for filing all amendments or changes forwarded by the agency.

(e) Availability in relation to fair hearings. The agency must make available to an applicant or beneficiary, or his representative, a copy of the specific policy materials necessary—

(1) To determine whether to request a fair hearing; or

(2) To prepare for a fair hearing.

(f) Availability for other purposes. The agency must establish rules for making program policy materials available to individuals who request them for other purposes.

(g) Charges for reproduction. The agency must make copies of its program policy materials available without charge or at a charge related to the cost of reproduction.

[44 FR 17931, Mar. 23, 1979]
Notes of Decisions
Cited in 4 cases, 1987–1994 · leading case: Morgan v. Cohen, 665 F. Supp. 1164 (E.D. Pa. 1987).
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Morgan v. Cohen, 665 F. Supp. 1164 (E.D. Pa. 1987). “42 C.F.R. § 431.18 . These regulations enable independent oversight of DPW’s practices, providing a form of quality control.”
Seittelman v. Sabol, 158 Misc. 2d 498 (N.Y. Sup. Ct. 1993). · cites it 2× “42 CFR 431.18, which is entitled "Availability of agency program manuals” sets forth the requirements for facilitating access to Medicaid rules and policies by individuals outside the State Medicaid agency.”
Wood v. Wallace, 825 F. Supp. 177 (S.D. Ohio 1993). “§ 1396a(a)(17) arid 42 C.F.R. § 431.18 claims too are barred.”
Randy v. Tompkins, 33 F.3d 600 (6th Cir. 1994). “26, 1991) (holding that no § 1983 private right of action existed to remedy the violation of these statutes, which express mere "general policy goals” rather than specific guidelines); and Plaintiffs' claims under § 1396a(a)(17) and 42 C.F.R. § 431.18 were barred in light of…”
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