C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 440—SERVICES: GENERAL PROVISIONS › Subpart A—Definitions

42 C.F.R. § 440.40

Nursing facility services for individuals age 21 or older (other than services in an institution for mental disease), EPSDT, and family planning services and supplies

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(a) Nursing facility services. (1) “Nursing facility services for individuals age 21 or older, other than services in an institution for mental diseases”, means services that are—

(i) Needed on a daily basis and required to be provided on an inpatient basis under §§ 409.31 through 409.35 of this chapter.

(ii) Provided by—

(A) A facility or distinct part (as defined in § 483.5(b) of this chapter) that meets the requirements for participation under subpart B of part 483 of this chapter, as evidenced by a valid agreement between the Medicaid agency and the facility for providing nursing facility services and making payments for services under the plan; or

(B) If specified in the State plan, a swing-bed hospital that has an approval from CMS to furnish skilled nursing facility services in the Medicare program; and

(iii) Ordered by and provided under the direction of a physician.

(2) Nursing facility services include services provided by any facility located on an Indian reservation and certified by the Secretary as meeting the requirements of subpart B of part 483 of this chapter.

(b) EPSDT. “Early and periodic screening and diagnosis and treatment” means—

(1) Screening and diagnostic services to determine physical or mental defects in beneficiaries under age 21; and

(2) Health care, treatment, and other measures to correct or ameliorate any defects and chronic conditions discovered. (See subpart B of part 441 of this chapter.)

(c) Family planning services and supplies for individuals of child-bearing age. [Reserved]

[59 FR 56233, Nov. 10, 1994; 60 FR 50117, Sept. 28, 1995, as amended at 61 FR 59198, Nov. 21, 1996; 68 FR 46071, Aug. 4, 2003]
Notes of Decisions
Cited in 15 cases, 1983–2018 · leading case: Persico v. Maher, 465 A.2d 308 (Conn. 1983).
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Persico v. Maher, 465 A.2d 308 (Conn. 1983). “” 42 C.F.R. § 440.40 (b) (2). Under the regulations, “[a] State plan must provide that the Medicaid agency meets the requirements of §§ 441.”
Thorpe v. Dist. of Columbia, 303 F.R.D. 120 (D.D.C. 2014). “§ 4200 (citing 42 CFR § 440.40 ; 42 CFR § 440.155 ). A participant can receive up to sixteen hours of care per day without prior authorization and up to twenty-four hours with prior authorization.”
State of Wisconsin, Dep't of Health & Soc. Servs., Plaintiff v. Otis R. Bowen, Sec'y of Health & Human Servs., 797 F.2d 391 (7th Cir. 1986). “§ 1396d(f); 42 C.F.R. § 440.40 ; an ICF provides a lower level of services for patients who nonetheless require institutional care, 42 U.”
Montgomery Cnty. Geriatric & Rehab. Ctr. v. Commonwealth, Dep't of Pub. Welfare, 462 A.2d 325 (Pa. Commw. Ct. 1983). “40(a)____” Under 42 C.F.R. §440.40 (a)(ii), “[sjkilled nursing facility services .”
Hillburn v. Maher, 795 F.2d 252 (2d Cir. 1986). · cites it 2× “§ 1396d(f) and 42 C.F.R. § 440.40 (a) (1985), and (2) payments to suppliers for other Medicaid benefits.”
Maryland Dep't of Health & Mental Hygiene v. Brown, 935 A.2d 1128 (Md. Ct. Spec. App. 2007). “” *449 The regulation that addresses skilled level care, 42 C.F.R. § 440.40 (a)(i), describes skilled nursing services as those that are “[n]eeded on a daily basis and required to be provided on an inpatient basis under §§ 409.”
Oklahoma Chapter of the Am. Academy of Pediatrics v. Fogarty, 366 F. Supp. 2d 1050 (N.D. Okla. 2005). “, for implementation of the program in accordance with the requirements imposed by Title XIX, its regulations, 42 C.F.R. § 440.40 (b), 441-50 et seq., the terms of its waiver, and policy directions such as CMS’s State Medicaid Manual.”
Koss v. Norwood, 305 F. Supp. 3d 897 (E.D. Ill. 2018). “, 42 C.F.R. § 440.40 (a) (West 2018) (defining "nursing facility services").”
Slepicka v. State, 2015 IL App (4th) 121103-B (Ill. App. Ct. 2015). “155 of this chapter [( 42 C.F.R. §§ 440.40 , 440.155 (2011))]) ***.”
Oklahoma Chap. of Amer. Aca., Pediat. v. Fogarty, 366 F. Supp. 2d 1050 (N.D. Okla. 2005). “, for implementation of the program in accordance with the requirements imposed by Title XIX, its regulations, 42 C.F.R. § 440.40 (b), 441-50 et seq., the terms of its waiver, and policy directions such as CMS's State Medicaid Manual.”
Koss v. Eagleson (N.D. Ill. 2018). “, 42 C.F.R. § 440.40 (a) (West 2018) (defining “nursing facility services”).”
Steven Fuller, by His Next Friend, Theresa-Vay Smith v. Mark Emkes, Comm'r, Tennessee Dep't of Fin. & Admin. (Tenn. Ct. App. 2011). “” 42 C.F.R. § 440.40 (b). Pursuant to the EPSDT program, at a minimum, dental services should be provided for “the relief of pain and infections, restoration of teeth, and maintenance of dental health.”
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