Title 42 C.F.R. — Public Health

7257 sections

PART 2a

• § 2a.1 — Applicability
• § 2a.2 — Definitions
• § 2a.3 — Application; coordination
• § 2a.4 — Contents of application; in general
• § 2a.5 — Contents of application; research projects in which drugs will be administered
• § 2a.6 — Issuance of Confidentiality Certificates; single project limitation
• § 2a.7 — Effect of Confidentiality Certificate
• § 2a.8 — Termination

PART 2

• § 2.1 — Statutory authority for confidentiality of substance use disorder patient records
• § 2.2 — Purpose and effect
• § 2.3 — Civil and criminal penalties for violations
• § 2.4 — Complaints of noncompliance
• § 2.11 — Definitions
• § 2.12 — Applicability
• § 2.13 — Confidentiality restrictions and safeguards
• § 2.14 — Minor patients
• § 2.15 — Patients who lack capacity and deceased patients
• § 2.16 — Security for records and notification of breaches
• § 2.17 — Undercover agents and informants
• § 2.18 — Restrictions on the use of identification cards
• § 2.19 — Disposition of records by discontinued programs
• § 2.20 — Relationship to state laws
• § 2.21 — Relationship to federal statutes protecting research subjects against compulsory disclosure of their identity
• § 2.22 — Notice to patients of Federal confidentiality requirements
• § 2.23 — Patient access and restrictions on use and disclosure
• § 2.24 — Requirements for intermediaries
• § 2.25 — Accounting of disclosures
• § 2.26 — Right to request privacy protection for records
• § 2.31 — Consent requirements
• § 2.32 — Notice and copy of consent to accompany disclosure
• § 2.33 — Uses and disclosures permitted with written consent
• § 2.34 — Uses and Disclosures to prevent multiple enrollments
• § 2.35 — Disclosures to elements of the criminal justice system which have referred patients
• § 2.36 — Disclosures to prescription drug monitoring programs
• § 2.51 — Medical emergencies
• § 2.52 — Scientific research
• § 2.53 — Management audits, financial audits, and program evaluation
• § 2.54 — Disclosures for public health
• § 2.61 — Legal effect of order
• § 2.62 — Order not applicable to records disclosed without consent to researchers, auditors, and evaluators
• § 2.63 — Confidential communications
• § 2.64 — Procedures and criteria for orders authorizing uses and disclosures for noncriminal purposes
• § 2.65 — Procedures and criteria for orders authorizing use and disclosure of records to criminally investigate or prosecute patients
• § 2.66 — Procedures and criteria for orders authorizing use and disclosure of records to investigate or prosecute a part 2 program or the person holding the records
• § 2.67 — Orders authorizing the use of undercover agents and informants to investigate employees or agents of a part 2 program in connection with a criminal matter
• § 2.68 — Report to the Secretary

PART 3

• § 3.10 — Purpose
• § 3.20 — Definitions
• § 3.102 — Process and requirements for initial and continued listing of PSOs
• § 3.104 — Secretarial actions
• § 3.106 — Security requirements
• § 3.108 — Correction of deficiencies, revocation, and voluntary relinquishment
• § 3.110 — Assessment of PSO compliance
• § 3.112 — Submissions and forms
• § 3.204 — Privilege of patient safety work product
• § 3.206 — Confidentiality of patient safety work product
• § 3.208 — Continued protection of patient safety work product
• § 3.210 — Required disclosure of patient safety work product to the Secretary
• § 3.212 — Nonidentification of patient safety work product
• § 3.304 — Principles for achieving compliance
• § 3.306 — Complaints to the Secretary
• § 3.308 — Compliance reviews
• § 3.310 — Responsibilities of respondents
• § 3.312 — Secretarial action regarding complaints and compliance reviews
• § 3.314 — Investigational subpoenas and inquiries
• § 3.402 — Basis for a civil money penalty
• § 3.404 — Amount of a civil money penalty
• § 3.408 — Factors considered in determining the amount of a civil money penalty
• § 3.414 — Limitations
• § 3.416 — Authority to settle
• § 3.418 — Exclusivity of penalty
• § 3.420 — Notice of proposed determination
• § 3.422 — Failure to request a hearing
• § 3.424 — Collection of penalty
• § 3.426 — Notification of the public and other agencies
• § 3.504 — Hearings before an ALJ
• § 3.506 — Rights of the parties
• § 3.508 — Authority of the ALJ
• § 3.510 — Ex parte contacts
• § 3.512 — Prehearing conferences
• § 3.514 — Authority to settle
• § 3.516 — Discovery
• § 3.518 — Exchange of witness lists, witness statements, and exhibits
• § 3.520 — Subpoenas for attendance at hearing
• § 3.522 — Fees
• § 3.524 — Form, filing, and service of papers
• § 3.526 — Computation of time
• § 3.528 — Motions
• § 3.530 — Sanctions
• § 3.532 — Collateral estoppel
• § 3.534 — The hearing
• § 3.538 — Witnesses
• § 3.540 — Evidence
• § 3.542 — The record
• § 3.544 — Post hearing briefs
• § 3.546 — ALJ's decision
• § 3.548 — Appeal of the ALJ's decision
• § 3.550 — Stay of the Secretary's decision
• § 3.552 — Harmless error

PART 4

• § 4.1 — Programs to which these regulations apply
• § 4.2 — Definitions
• § 4.3 — Purpose of the Library
• § 4.4 — Use of Library facilities
• § 4.5 — Use of materials from the collections
• § 4.6 — Reference, bibliographic, reproduction, and consultation services
• § 4.7 — Fees
• § 4.8 — Publication of the Library and information about the Library

PART 5

• § 5.1 — Purpose
• § 5.2 — Definitions
• § 5.3 — Procedures for designation of health professional(s) shortage areas
• § 5.4 — Notification and publication of designations and withdrawals

PART 6

• § 6.1 — Applicability
• § 6.2 — Definitions
• § 6.3 — Eligible entities
• § 6.4 — Covered individuals
• § 6.5 — Deeming process for eligible entities
• § 6.6 — Covered acts and omissions

PART 7

• § 7.1 — Applicability
• § 7.2 — Establishment of a user charge
• § 7.3 — Definitions
• § 7.4 — Schedule of charges
• § 7.5 — Payment procedures
• § 7.6 — Exemptions

PART 8

• § 8.1 — Scope
• § 8.2 — Definitions
• § 8.3 — Application for approval as an Accreditation Body
• § 8.4 — Accreditation Body responsibilities
• § 8.5 — Periodic evaluation of Accreditation Bodies
• § 8.6 — Withdrawal of approval of Accreditation Bodies
• § 8.11 — Opioid Treatment Program certification
• § 8.12 — Federal Opioid Use Disorder treatment standards
• § 8.13 — Revocation of accreditation and Accreditation Body approval
• § 8.14 — Suspension or revocation of certification
• § 8.15 — Forms
• § 8.21 — Applicability
• § 8.22 — Definitions
• § 8.23 — Limitation on issues subject to review
• § 8.24 — Specifying who represents the parties
• § 8.25 — Informal review and the reviewing official's response
• § 8.26 — Preparation of the review file and written arguments
• § 8.27 — Opportunity for oral presentation
• § 8.28 — Expedited procedures for review of immediate suspension
• § 8.29 — Ex parte communications
• § 8.30 — Transmission of written communications by reviewing official and calculation of deadlines
• § 8.31 — Authority and responsibilities of the reviewing official
• § 8.32 — Administrative record
• § 8.33 — Written decision
• § 8.34 — Court review of final administrative action; exhaustion of administrative remedies

PART 9

• § 9.1 — Applicability and purpose
• § 9.2 — Definitions
• § 9.3 — Sanctuary policies and responsibilities
• § 9.4 — Physical facility policies and design
• § 9.5 — Chimpanzee ownership, fees, and studies
• § 9.6 — Animal care, well-being, husbandry, veterinary care, and euthanasia
• § 9.7 — Reproduction
• § 9.8 — Animal records
• § 9.9 — Facility staffing
• § 9.10 — Occupational Health and Safety Program (OHSP) and biosafety requirements
• § 9.11 — Animal transport
• § 9.12 — Compliance with the Standards of Care, and USDA and PHS policies and regulations
• § 9.13 — Other federal laws, regulations, and statutes that apply to the sanctuary

PART 10

• § 10.1 — Purpose
• § 10.2 — Summary of 340B Drug Pricing Program
• § 10.3 — Definitions
• § 10.10 — Ceiling price for a covered outpatient drug
• § 10.11 — Manufacturer civil monetary penalties
• § 10.20 — 340B Administrative Dispute Resolution Panel
• § 10.21 — Claims
• § 10.22 — Covered entity information and document requests
• § 10.23 — 340B ADR Panel decision process
• § 10.24 — 340B ADR Panel decision reconsideration process
• § 10.25 — Severability

PART 11

• § 11.2 — What is the purpose of this part?
• § 11.4 — To whom does this part apply?
• § 11.6 — What are the requirements for the submission of truthful information?
• § 11.8 — In what format must clinical trial information be submitted?
• § 11.10 — What definitions apply to this part?
• § 11.20 — Who must submit clinical trial registration information?
• § 11.22 — Which applicable clinical trials must be registered?
• § 11.24 — When must clinical trial registration information be submitted?
• § 11.28 — What constitutes clinical trial registration information?
• § 11.35 — By when will the NIH Director post clinical trial registration information submitted under § 11.28?
• § 11.40 — Who must submit clinical trial results information?
• § 11.42 — For which applicable clinical trials must clinical trial results information be submitted?
• § 11.44 — When must clinical trial results information be submitted for applicable clinical trials subject to § 11.42?
• § 11.48 — What constitutes clinical trial results information?
• § 11.52 — By when will the NIH Director post submitted clinical trial results information?
• § 11.54 — What are the procedures for requesting and obtaining a waiver of the requirements for clinical trial results information submission?
• § 11.60 — What requirements apply to the voluntary submission of clinical trial information for clinical trials of FDA-regulated drug products (including biological products) and device products?
• § 11.62 — What requirements apply to applicable clinical trials for which submission of clinical trial information has been determined by the Director to be necessary to protect the public health?
• § 11.64 — When must clinical trial information submitted to ClinicalTrials.gov be updated or corrected?
• § 11.66 — What are potential legal consequences of not complying with the requirements of this part?

PART 12

• § 12.1 — Temporary extension of certain COVID-19 telemedicine flexibilities for prescription of controlled medications
• § 12.2 — [Reserved]
• § 12.3 — Telemedicine prescribing of schedule III-V medications for the treatment of Opioid Use Disorder
• § 12.4 — Telemedicine prescribing of schedule II-V medications by the Department of Veterans Affairs practitioners

PART 21

• § 21.1 — Meaning of terms
• § 21.21 — Meaning of terms
• § 21.22 — Submission of application and evidence of qualifications
• § 21.23 — False statements as disqualification
• § 21.24 — Physical examinations
• § 21.25 — Eligibility; junior assistant grade
• § 21.26 — Eligibility; assistant grade
• § 21.27 — Eligibility; senior assistant grade
• § 21.28 — Age requirements, Regular Corps, senior assistant grade and below
• § 21.29 — Eligibility; grades above senior assistant grade
• § 21.30 — Determination of creditable years of educational and professional training and experience
• § 21.31 — Eligibility; all grades; academic and professional education and professional training and experience
• § 21.32 — Boards; appointment of; powers and duties
• § 21.33 — General service
• § 21.34 — Certification by candidate; requirement of new physical examination
• § 21.41 — Professional examinations, holding of; subjects to be included
• § 21.42 — Examinations; junior assistant, assistant, or senior assistant grade
• § 21.43 — Examination; full grade and above
• § 21.44 — Clinical or other practical demonstration
• § 21.45 — Rating values
• § 21.46 — Merit roll
• § 21.47 — Examination; anticipation of meeting qualifications
• § 21.51 — Appointment of officers having specialized training or experience in administration and management
• § 21.52 — Waiver of entrance qualifications for original appointment in time of war or national emergency
• § 21.53 — Examination
• § 21.54 — Students
• § 21.55 — Appointment to higher grades; candidates exceptionally qualified in specialized fields
• § 21.56 — Reappointment
• § 21.57 — Examination for reappointment
• § 21.58 — Physical examination for reappointment
• § 21.70 — Purpose
• § 21.71 — Applicability and scope
• § 21.72 — Definitions
• § 21.73 — Policy
• § 21.74 — Responsibilities
• § 21.75 — Procedures

PART 22

• § 22.3 — Appointment of special consultants
• § 22.5 — Leave without pay while on detail

PART 23

• § 23.1 — To what entities does this regulation apply?
• § 23.2 — Definitions
• § 23.3 — What entities are eligible to apply for assignment?
• § 23.4 — How must an entity apply for assignment?
• § 23.5 — What are the criteria for deciding which applications for assignment will be approved?
• § 23.6 — What are the criteria for determining the entities to which National Health Service Corps personnel will be assigned?
• § 23.7 — What must an entity agree to do before the assignment is made?
• § 23.8 — What operational requirements apply to an entity to which National Health Service Corps personnel are assigned?
• § 23.9 — What must an entity to which National Health Service Corps personnel are assigned (i.e., a National Health Service Corps site) charge for the provision of health services by assigned personnel?
• § 23.10 — Under what circumstances may a National Health Service Corps site's reimbursement obligation to the Federal Government be waived?
• § 23.11 — Under what circumstances may the Secretary sell equipment or other property of the United States used by the National Health Service Corps site?
• § 23.12 — Who will supervise and control the assigned personnel?
• § 23.13 — What nondiscrimination requirements apply to National Health Service Corps sites?

PART 24

• § 24.1 — Establishment, number of members, and purpose
• § 24.2 — Allocation
• § 24.3 — Policy Board
• § 24.4 — Eligibility
• § 24.5 — Pay and compensation
• § 24.6 — Performance appraisal system
• § 24.7 — Inapplicability of provisions regarding appointments
• § 24.8 — Removal from the Service
• § 24.9 — Reporting

PART 31

• § 31.1 — Meaning of terms
• § 31.2 — Persons entitled to treatment
• § 31.3 — Use of Service facilities
• § 31.4 — Use of other than Service facilities
• § 31.5 — Application for treatment; active duty personnel
• § 31.6 — Personnel absent without leave
• § 31.7 — Continuance of medical relief after loss of status
• § 31.8 — Retired personnel; extent of treatment
• § 31.9 — Dependent members of families; treatment
• § 31.10 — Dependent members of families; use of Service facilities
• § 31.11 — Persons entitled to treatment
• § 31.12 — Use of Service facilities
• § 31.13 — Use of other than Service facilities
• § 31.14 — Application for treatment; active duty personnel
• § 31.15 — Continuance of medical relief after loss of status
• § 31.16 — Retired personnel; extent of treatment

PART 34

• § 34.1 — Applicability
• § 34.2 — Definitions
• § 34.3 — Scope of examinations
• § 34.4 — Medical notifications
• § 34.5 — Postponement of medical examination
• § 34.6 — Applicability of foreign quarantine regulations
• § 34.7 — Medical and other care; death
• § 34.8 — Reexamination; convening of review boards; expert witnesses; reports

PART 35

• § 35.1 — Hospital and station rules
• § 35.2 — Compliance with hospital rules
• § 35.3 — Noncompliance; deprivation of privileges
• § 35.4 — Noncompliance; discharge or transfer
• § 35.5 — Entitlement to care after discharge or transfer by reason of noncompliance
• § 35.6 — Admissions; determination of eligibility for care
• § 35.7 — Admissions; designation of person to be notified
• § 35.8 — Safekeeping of money and effects; withdrawals
• § 35.9 — Disposition of money and effects left by other than deceased patients
• § 35.10 — Destruction of effects dangerous to health
• § 35.11 — Clinical records; confidential
• § 35.12 — Solicitation of legal business prohibited
• § 35.13 — Entry for negotiation of release or settlement
• § 35.14 — Solicitation of legal business; negotiation of release or settlement; assistance prohibited
• § 35.15 — Consent to operative procedures
• § 35.16 — Autopsies and other post-mortem operations
• § 35.17 — Fees and charges for copying, certification, search of records and related services
• § 35.21 — Authorization of transfer
• § 35.22 — Attendants
• § 35.31 — Retention by patients
• § 35.32 — Board of appraisers
• § 35.33 — Sale; prices; deposit of proceeds
• § 35.34 — Resale
• § 35.35 — Unsalable articles
• § 35.41 — Inventory
• § 35.42 — Notice upon death
• § 35.43 — Delivery only upon filing claim; forms; procedure
• § 35.44 — Delivery to legal representative; to other claimants if value is $1,000 or less
• § 35.45 — Disposition of effects; exceptions
• § 35.46 — Conflicting claims
• § 35.47 — Disposition of Government checks
• § 35.48 — Deposit of unclaimed money; sale of unclaimed effects and deposit of proceeds
• § 35.49 — Sale of unclaimed effects; procedures
• § 35.50 — Disposition of unsold effects
• § 35.51 — Manner of delivery; costs, receipts
• § 35.52 — Delivery of possession only; title unaffected
• § 35.61 — Applicability
• § 35.62 — Acceptance of contributions
• § 35.63 — Report of and accounting for contributions
• § 35.64 — Donors
• § 35.65 — Acceptable personal property
• § 35.66 — Expenditure of cash contributions

PART 37

• § 37.1 — Scope
• § 37.2 — Definitions
• § 37.3 — Chest radiographs required for miners
• § 37.4 — Chest radiographic examinations conducted by the Secretary
• § 37.10 — Standards incorporated by reference
• § 37.20 — Miner identification document
• § 37.40 — General provisions
• § 37.41 — Chest radiograph specifications—film
• § 37.42 — Chest radiograph specifications—digital radiography systems
• § 37.43 — Approval of radiographic facilities that use film radiography systems
• § 37.44 — Approval of radiographic facilities that use digital radiography systems
• § 37.45 — Protection against radiation emitted by radiographic equipment
• § 37.50 — Interpreting and classifying chest radiographs—film radiography systems
• § 37.51 — Interpreting and classifying chest radiographs—digital radiography systems
• § 37.52 — Proficiency in the use of systems for classifying the pneumoconioses
• § 37.53 — Method of obtaining definitive chest radiograph classifications
• § 37.54 — Notification of abnormal radiographic findings
• § 37.60 — Submitting required chest radiograph classification and miner identification documents
• § 37.70 — Review of classifications
• § 37.80 — Availability of records for radiographs
• § 37.90 — Scope
• § 37.91 — Definitions
• § 37.92 — Spirometry testing required for miners
• § 37.93 — Approval of spirometry facilities
• § 37.94 — Respiratory assessment form
• § 37.95 — Specifications for performing spirometry tests
• § 37.96 — Spirometry interpretations, reports, and submission
• § 37.97 — Notification of spirometry results
• § 37.98 — Standards incorporated by reference
• § 37.100 — Coal mine operator plan for medical examinations
• § 37.101 — Approval of plans
• § 37.102 — Transfer of affected miner to less dusty area
• § 37.103 — Medical examination at miner's expense
• § 37.200 — Scope
• § 37.201 — Definitions
• § 37.202 — Payment for autopsy
• § 37.203 — Autopsy specifications
• § 37.204 — Procedure for obtaining payment

PART 38

• § 38.1 — Purpose; coordination
• § 38.2 — Definitions
• § 38.3 — Assistance; procedures, limitations
• § 38.4 — Contracts
• § 38.5 — Grant assistance
• § 38.6 — Nondiscrimination
• § 38.7 — Nonliability
• § 38.8 — Criminal and civil penalties
• § 38.9 — Federal audits

PART 50

• § 50.201 — Applicability
• § 50.202 — Definitions
• § 50.203 — Sterilization of a mentally competent individual aged 21 or older
• § 50.204 — Informed consent requirement
• § 50.205 — Consent form requirements
• § 50.206 — Sterilization of a mentally incompetent individual or of an institutionalized individual
• § 50.207 — Sterilization by hysterectomy
• § 50.208 — Program or project requirements
• § 50.209 — Use of Federal financial assistance
• § 50.210 — Review of regulation
• § 50.301 — Applicability
• § 50.302 — Definitions
• § 50.303 — General rule
• § 50.304 — Life of the mother would be endangered
• § 50.305 — [Reserved]
• § 50.306 — Rape and incest
• § 50.307 — Documentation needed by programs or projects
• § 50.308 — Drugs and devices and termination of ectopic pregnancies
• § 50.309 — Recordkeeping requirements
• § 50.310 — Confidentiality
• § 50.401 — What is the purpose of this subpart?
• § 50.402 — To what program do these regulations apply?
• § 50.403 — What is the policy basis for these procedures?
• § 50.404 — What disputes are covered by these procedures?
• § 50.405 — What is the structure of review committees?
• § 50.406 — What are the steps in the process?
• § 50.501 — Applicability
• § 50.502 — Definitions
• § 50.503 — Policy
• § 50.504 — Allowable cost of drugs
• § 50.601 — Purpose
• § 50.602 — Applicability
• § 50.603 — Definitions
• § 50.604 — Responsibilities of Institutions regarding Investigator financial conflicts of interest
• § 50.605 — Management and reporting of financial conflicts of interest
• § 50.606 — Remedies
• § 50.607 — Other HHS regulations that apply

PART 51a

• § 51a.1 — To which programs does this regulation apply?
• § 51a.2 — Definitions
• § 51a.3 — Who is eligible to apply for Federal funding?
• § 51a.4 — How is application made for Federal funding?
• § 51a.5 — What criteria will DHHS use to decide which projects to fund?
• § 51a.6 — What confidentiality requirements must be met?
• § 51a.7 — What other DHHS regulations apply?
• § 51a.8 — What other conditions apply to these grants?

PART 51b

• § 51b.101 — To which programs do these regulations apply?
• § 51b.102 — Definitions
• § 51b.103 — What are the general application requirements?
• § 51b.104 — Can personnel, supplies, and related items be provided in lieu of cash?
• § 51b.105 — Which other HHS regulations apply to these grants?
• § 51b.106 — What other conditions apply to these grants?
• § 51b.107 — Is participation in preventive health service programs required by these regulations?
• § 51b.201 — To which programs does this subpart apply?
• § 51b.202 — Definitions
• § 51b.203 — Who is eligible for a grant under this subpart?
• § 51b.204 — What information is required in the application?
• § 51b.205 — How will grant applications be evaluated and the grants awarded?
• § 51b.206 — How can grant funds be used?
• § 51b.401 — To which programs does this subpart apply?
• § 51b.402 — Definitions
• § 51b.403 — Who is eligible for a grant under this subpart?
• § 51b.404 — What are the confidentiality requirements?
• § 51b.405 — What information is required in the application?
• § 51b.406 — How will grant applications be evaluated and the grants awarded?
• § 51b.407 — How can grant funds be used?
• § 51b.601 — To which programs does this subpart apply?
• § 51b.602 — Who is eligible for a grant under this subpart?
• § 51b.603 — What are the confidentiality requirements?
• § 51b.604 — What information is required in the application?
• § 51b.605 — How will grant applications be evaluated and the grants awarded?
• § 51b.606 — How can grant funds be used?

PART 51c

• § 51c.101 — Applicability
• § 51c.102 — Definitions
• § 51c.103 — Eligibility
• § 51c.104 — Application
• § 51c.105 — Accord with health planning
• § 51c.106 — Amount of grant
• § 51c.107 — Use of project funds
• § 51c.108 — Grant payments
• § 51c.109 — Nondiscrimination
• § 51c.110 — Confidentiality
• § 51c.111 — Publications and copyright
• § 51c.112 — Grantee accountability
• § 51c.113 — Applicability of 2 CFR parts 200 and 300
• § 51c.201 — Applicability
• § 51c.202 — Application
• § 51c.203 — Project elements
• § 51c.204 — Grant evaluation and award
• § 51c.301 — Applicability
• § 51c.302 — Application
• § 51c.303 — Project elements
• § 51c.304 — Governing board
• § 51c.305 — Grant evaluation and award
• § 51c.401 — Applicability
• § 51c.402 — Application
• § 51c.403 — Project elements
• § 51c.404 — Grant evaluation and award
• § 51c.501 — Applicability
• § 51c.502 — Definitions
• § 51c.503 — Application
• § 51c.504 — Project elements
• § 51c.505 — Determination of cost
• § 51c.506 — Use of grant funds
• § 51c.507 — Facility which has previously received Federal grant

PART 51d

• § 51d.1 — To what does this subpart apply?
• § 51d.10 — What are the reporting requirements?
• § 51d.2 — Definitions
• § 51d.3 — Who is eligible for an award under this subpart?
• § 51d.4 — What information is required in the application?
• § 51d.5 — How is an emergency determined to exist?
• § 51d.6 — How will applications be evaluated and awarded?
• § 51d.7 — What are the limitations on how award funds may be used?
• § 51d.8 — Which other HHS regulations apply to these awards?
• § 51d.9 — What other conditions apply to these awards?

PART 51

• § 51.1 — Scope
• § 51.2 — Definitions
• § 51.3 — Formula for determining allotments
• § 51.4 — Grants administration requirements
• § 51.5 — Eligibility for allotment
• § 51.6 — Use of allotments
• § 51.7 — Eligibility for protection and advocacy services
• § 51.8 — Annual reports
• § 51.9 — [Reserved]
• § 51.10 — Remedial actions
• § 51.11-51.20 — 51.11-51.20 [Reserved]
• § 51.21 — Contracts for program operations
• § 51.22 — Governing authority
• § 51.23 — Advisory council
• § 51.24 — Program priorities
• § 51.25 — Grievance procedure
• § 51.26 — Conflicts of interest
• § 51.27 — Training
• § 51.28-51.30 — 51.28-51.30 [Reserved]
• § 51.31 — Conduct of protection and advocacy activities
• § 51.32 — Resolving disputes
• § 51.33-51.40 — 51.33-51.40 [Reserved]
• § 51.41 — Access to records
• § 51.42 — Access to facilities and residents
• § 51.43 — Denial or delay of access
• § 51.44 — [Reserved]
• § 51.45 — Confidentiality of protection and advocacy system records
• § 51.46 — Disclosing information obtained from a provider of mental health services

PART 52a

• § 52a.1 — To which programs do these regulations apply?
• § 52a.2 — Definitions
• § 52a.3 — Who is eligible to apply?
• § 52a.4 — What information must each application contain?
• § 52a.5 — How will NIH evaluate applications?
• § 52a.6 — Information about grant awards
• § 52a.7 — For what purposes may a grantee spend grant funds?
• § 52a.8 — Other HHS regulations and policies that apply
• § 52a.9 — Additional conditions

PART 52b

• § 52b.1 — To what programs do these regulations apply?
• § 52b.10 — What are the terms and conditions of awards?
• § 52b.11 — What are the requirements for acquisition and modernization of existing facilities?
• § 52b.12 — What are the minimum requirements of construction and equipment?
• § 52b.13 — Additional conditions
• § 52b.14 — Other Federal laws, regulations, Executive orders, and policies that apply
• § 52b.2 — Definitions
• § 52b.3 — Who is eligible to apply?
• § 52b.4 — How to apply
• § 52b.5 — How will NIH evaluate applications?
• § 52b.6 — What is the rate of federal financial participation?
• § 52b.7 — How is the grantee obligated to use the facility?
• § 52b.8 — How will NIH monitor the use of facilities constructed with federal funds?
• § 52b.9 — What is the right of the United States to recover Federal funds when facilities are not used for research or are transferred?

PART 52d

• § 52d.1 — Applicability
• § 52d.2 — Definitions
• § 52d.3 — Eligibility
• § 52d.4 — Application
• § 52d.5 — Program requirements
• § 52d.6 — Grant awards
• § 52d.7 — Expenditure of grant funds
• § 52d.8 — Other HHS regulations that apply
• § 52d.9 — Additional conditions

PART 52e

• § 52e.1 — To what programs do these regulations apply?
• § 52e.2 — Definitions
• § 52e.3 — Who is eligible to apply?
• § 52e.4 — How to apply
• § 52e.5 — What are the project requirements?
• § 52e.6 — How will NIH evaluate applications?
• § 52e.7 — What are the terms and conditions of awards?
• § 52e.8 — Other HHS regulations and policies that apply
• § 52e.9 — Additional conditions

PART 52h

• § 52h.1 — Applicability
• § 52h.10 — What matters must be reviewed for solicited contract proposals?
• § 52h.11 — What are the review criteria for contract projects and proposals?
• § 52h.12 — Other regulations that apply
• § 52h.2 — Definitions
• § 52h.3 — Establishment and operation of peer review groups
• § 52h.4 — Composition of peer review groups
• § 52h.5 — Conflict of interest
• § 52h.6 — Availability of information
• § 52h.7 — What matters must be reviewed for grants?
• § 52h.8 — What are the review criteria for grants?
• § 52h.9 — What matters must be reviewed for unsolicited contract proposals?

PART 52i

• § 52i.1 — To what program does this part apply?
• § 52i.10 — How shall a grantee calculate the amount of endowment fund income that it may withdraw and spend?
• § 52i.11 — What shall a grantee record and report?
• § 52i.12 — What happens if a grantee fails to administer the research endowment grant in accordance with applicable regulations?
• § 52i.13 — Other HHS policies and regulations that apply
• § 52i.14 — Additional conditions
• § 52i.2 — Definitions
• § 52i.3 — Who is eligible to apply?
• § 52i.4 — Under what conditions may an eligible institution designate a foundation as the recipient of a research endowment grant?
• § 52i.5 — How to apply for a grant
• § 52i.6 — Evaluation and award of research endowment grant applications
• § 52i.7 — Grant awards
• § 52i.8 — When and for what purposes may a grantee spend the endowment fund corpus?
• § 52i.9 — How much endowment fund income may a grantee spend and for what purposes?

PART 52

• § 52.1 — To which programs do these regulations apply?
• § 52.2 — Definitions
• § 52.3 — Who is eligible to apply for a grant?
• § 52.4 — How to apply for a grant
• § 52.5 — Evaluation and disposition of applications
• § 52.6 — Grant awards
• § 52.7 — Use of funds; changes
• § 52.8 — Other HHS regulations and policies that apply
• § 52.9 — Additional conditions

PART 53

• § 53.111 — Services for persons unable to pay
• § 53.112 — Nondiscrimination
• § 53.113 — Community service
• § 53.154 — Waiver of right of recovery
• § 53.155 — Modification of loans
• § 53.156 — Fees for modification requests

PART 54a

• § 54a.1 — Scope
• § 54a.10 — Fiscal accountability
• § 54a.11 — Effect on State and local funds
• § 54a.12 — Treatment of intermediate organizations
• § 54a.13 — Educational requirements for personnel in drug treatment programs
• § 54a.14 — Determination of nonprofit status
• § 54a.2 — Definitions
• § 54a.3 — Nondiscrimination against religious organizations
• § 54a.4 — Religious activities
• § 54a.5 — Religious character and independence
• § 54a.6 — Employment practices
• § 54a.7 — Nondiscrimination requirement
• § 54a.8 — Right to services from an alternative provider
• § 54a.9 — Oversight of the Charitable Choice requirements

PART 54

• § 54.1 — Scope
• § 54.2 — Definitions
• § 54.3 — Nondiscrimination against religious organizations
• § 54.4 — Religious activities
• § 54.5 — Religious character and independence
• § 54.6 — Employment practices
• § 54.7 — Nondiscrimination requirement
• § 54.8 — Right to services from an alternative provider
• § 54.9 — Assurances and State oversight of the Charitable Choice requirements
• § 54.10 — Fiscal accountability
• § 54.11 — Effects on State and local funds
• § 54.12 — Treatment of intermediate organizations
• § 54.13 — Educational requirements for personnel in drug treatment programs

PART 55a

• § 55a.101 — Definitions
• § 55a.102 — Who is eligible to apply for a Black Lung clinics grant?
• § 55a.103 — What criteria has HHS established for deciding which grant application to fund?
• § 55a.104 — What confidentiality requirements must be met?
• § 55a.105 — How must grantees carry out their projects?
• § 55a.106 — Provision for waiver by the Secretary
• § 55a.107 — What other regulations apply?
• § 55a.201 — What is required for a State application?
• § 55a.301 — What is required for an application from an entity other than a State?

PART 56

• § 56.101 — Applicability
• § 56.102 — Definitions
• § 56.103 — Eligibility
• § 56.104 — Application
• § 56.105 — Accord with health planning
• § 56.106 — Amount of grant
• § 56.107 — Priorities for grants
• § 56.108 — Use of grant funds
• § 56.109 — Grant payments
• § 56.110 — Nondiscrimination
• § 56.111 — Confidentiality
• § 56.112 — Publications and copyright
• § 56.113 — Grantee accountability
• § 56.114 — Applicability of 2 CFR parts 200 and 300
• § 56.201 — Applicability
• § 56.202 — Application
• § 56.203 — Project elements
• § 56.204 — Grant evaluation and award
• § 56.301 — Applicability
• § 56.302 — Application
• § 56.303 — Project elements
• § 56.304 — Governing board
• § 56.305 — Grant evaluation and award
• § 56.401 — Applicability
• § 56.402 — Application
• § 56.403 — Project elements
• § 56.404 — Grant evaluation and award
• § 56.501 — Applicability
• § 56.502 — Application
• § 56.503 — Project elements
• § 56.504 — Grant evaluation and award
• § 56.601 — Applicability
• § 56.602 — Application
• § 56.603 — Project elements
• § 56.604 — Grant evaluation and award
• § 56.701 — Applicability
• § 56.702 — Application
• § 56.703 — Project elements
• § 56.704 — Grant evaluation and award
• § 56.801 — Applicability of 42 CFR part 51c, subpart E

PART 57

• § 57.201 — Applicability
• § 57.202 — Definitions
• § 57.203 — Application by school
• § 57.204 — Payment of Federal capital contributions and reallocation of funds remitted to the Secretary
• § 57.205 — Health professions student loan funds
• § 57.206 — Eligibility and selection of health professions student loan applicants
• § 57.207 — Maximum amount of health professions student loans
• § 57.208 — Health professions student loan promissory note and disclosure requirements
• § 57.209 — Payment of health professions student loans
• § 57.210 — Repayment and collection of health professions student loans
• § 57.211 — Cancellation of health professions students loans for disability or death
• § 57.212 — [Reserved]
• § 57.213 — Continuation of provisions for cancellation of loans made prior to November 18, 1971
• § 57.213a — Loan cancellation reimbursement
• § 57.214 — Repayment of loans made after November 17, 1971, for failure to complete a program of study
• § 57.215 — Records, reports, inspection, and audit
• § 57.216 — What additional Department regulations apply to schools?
• § 57.216a — Performance standard
• § 57.217 — Additional conditions
• § 57.218 — Noncompliance
• § 57.301 — Applicability
• § 57.302 — Definitions
• § 57.303 — Application by school
• § 57.304 — Payment of Federal capital contributions and reallocation of funds remitted to the Secretary
• § 57.305 — Nursing student loan funds
• § 57.306 — Eligibility and selection of nursing student loan applicants
• § 57.307 — Maximum amount of nursing student loans
• § 57.308 — Nursing student loan promissory note
• § 57.309 — Payment of nursing student loans
• § 57.310 — Repayment and collection of nursing student loans
• § 57.311 — Cancellation of nursing student loans for disability or death
• § 57.312 — Repayment of loans for service in a shortage area
• § 57.313 — Loan cancellation for full-time employment as a registered nurse
• § 57.313a — Loan cancellation reimbursement
• § 57.314 — Repayment of loans made after November 17, 1971, for failure to complete a program of study. 2
• § 57.315 — Records, reports, inspection, and audit
• § 57.316 — What additional Department regulations apply to schools?
• § 57.316a — Performance standard
• § 57.317 — Additional conditions
• § 57.318 — Noncompliance
• § 57.409 — Good cause for other use of completed facility
• § 57.1501 — Applicability
• § 57.1502 — Definitions
• § 57.1503 — Eligibility
• § 57.1504 — Application
• § 57.1505 — Approval of applications
• § 57.1506 — Priority
• § 57.1507 — Limitations applicable to loan guarantee
• § 57.1508 — Amount of interest subsidy payments; limitations
• § 57.1509 — Forms of credit and security instruments
• § 57.1510 — Security for loans
• § 57.1511 — Opinion of legal counsel
• § 57.1512 — Length and maturity of loans
• § 57.1513 — Repayment
• § 57.1514 — Loan guarantee and interest subsidy agreements
• § 57.1515 — Loan closing
• § 57.1516 — Right of recovery-subordination
• § 57.1517 — Waiver of right of recovery
• § 57.1518 — Modification of loans
• § 57.2001 — Applicability
• § 57.2002 — Definitions
• § 57.2003 — Determinations of increased enrollment solely for the program
• § 57.2201 — Applicability
• § 57.2202 — Definitions
• § 57.2203 — Eligibility
• § 57.2204 — Application
• § 57.2205 — Priority for selection of scholarship recipients
• § 57.2206 — Grant award
• § 57.2207 — Amount of scholarship grant
• § 57.2208 — Payment of scholarship grant
• § 57.2209 — Conditions of scholarship grant
• § 57.2210 — Failure to comply
• § 57.2211 — Waiver or suspension
• § 57.3201 — To which programs do these regulations apply?
• § 57.3202 — How will allowable increases be determined?

PART 59a

• § 59a.1 — Programs to which these regulations apply
• § 59a.11 — Programs to which these regulations apply
• § 59a.12 — Definitions
• § 59a.13 — Who is eligible for a grant?
• § 59a.14 — How to apply
• § 59a.15 — Awards
• § 59a.16 — What other conditions apply?
• § 59a.17 — Other HHS regulations that apply
• § 59a.2 — Definitions
• § 59a.3 — Who is eligible for a grant?
• § 59a.4 — How are grant applications evaluated?
• § 59a.5 — Awards
• § 59a.6 — How may funds or materials be used?
• § 59a.7 — Other HHS regulations that apply

PART 59

• § 59.1 — To what programs do these regulations apply?
• § 59.2 — Definitions
• § 59.3 — Who is eligible to apply for a family planning services grant?
• § 59.4 — How does one apply for a family planning services grant?
• § 59.5 — What requirements must be met by a family planning project?
• § 59.6 — What procedures apply to assure the suitability of informational and educational material (print and electronic)?
• § 59.7 — What criteria will the Department of Health and Human Services use to decide which family planning services projects to fund and in what amount?
• § 59.8 — How is a grant awarded?
• § 59.9 — For what purpose may grant funds be used?
• § 59.10 — Confidentiality
• § 59.11 — Additional conditions
• § 59.201 — Applicability
• § 59.202 — Definitions
• § 59.203 — Eligibility
• § 59.204 — Application for a grant
• § 59.205 — Project requirements
• § 59.206 — Evaluation and grant award
• § 59.207 — Payments
• § 59.208 — Use of project funds
• § 59.209 — Civil rights
• § 59.210 — Inventions or discoveries
• § 59.211 — Publications and copyright
• § 59.212 — Grantee accountability
• § 59.213 — [Reserved]
• § 59.214 — Additional conditions
• § 59.215 — Applicability of 2 CFR parts 200 and 300

PART 61

• § 61.1 — Definitions
• § 61.2 — Applicability
• § 61.3 — Purpose of regular fellowships
• § 61.4 — Establishment and conditions
• § 61.5 — Qualifications
• § 61.6 — Method of application
• § 61.7 — Review of applications; committees; awards
• § 61.8 — Benefits: Stipends; dependency allowances; travel allowances; vacation
• § 61.9 — Payments: Stipends; dependency allowances; travel allowances
• § 61.10 — Benefits: Tuition and other expenses
• § 61.11 — Payments: Tuition and other expenses
• § 61.12 — Accountability
• § 61.13 — Duration and continuation
• § 61.14 — Separate consideration of information concerning moral character or loyalty
• § 61.15 — Moral character or loyalty; reference to Special Review Committee; review and recommendation
• § 61.16 — Termination of or refusal to continue award on grounds relating to moral character or loyalty; hearing
• § 61.17 — Termination on grounds other than those relating to moral character or loyalty
• § 61.18 — Publications
• § 61.19 — Copyright and reproduction
• § 61.20 — Inventions or discoveries
• § 61.21 — Interest
• § 61.22 — Nondiscrimination
• § 61.30 — Definitions
• § 61.31 — Applicability
• § 61.32 — Purpose of service fellowships
• § 61.33 — Establishment of service fellowships
• § 61.34 — Qualifications
• § 61.35 — Method of application
• § 61.36 — Selection and appointment of service fellows
• § 61.37 — Stipends, allowances, and benefits
• § 61.38 — Duration of service fellowships

PART 62

• § 62.1 — What is the scope and purpose of the National Health Service Corps scholarship program?
• § 62.2 — Definitions
• § 62.3 — Who is eligible to apply for a scholarship program award?
• § 62.4 — To whom will scholarship program awards be available in addition to those individuals pursuing courses of study leading to degrees in medicine, osteopathy, or dentistry?
• § 62.5 — How is application made for a scholarship program award?
• § 62.6 — How will individuals be selected to participate in the scholarship program?
• § 62.7 — What will an individual be awarded for participating in the scholarship program?
• § 62.8 — What does an individual have to do in return for the scholarship program award?
• § 62.9 — Under what circumstances can the period of obligated service be deferred to complete approved graduate training?
• § 62.10 — What will happen if an individual does not comply with the terms and conditions of participating in the scholarship program?
• § 62.11 — When can a scholarship program payment obligation be discharged in bankruptcy?
• § 62.12 — Under what circumstances can the service or payment obligation be canceled, waived or suspended?
• § 62.13 — What are the limitations on the receipt of concurrent benefits?
• § 62.14 — What are the special provisions relating to recipients of awards under the PH/NHSC scholarship training program who will also receive awards under the scholarship program?
• § 62.21 — What is the scope and purpose of the National Health Service Corps Loan Repayment Program?
• § 62.22 — Definitions
• § 62.23 — How will individuals be selected to participate in the Loan Repayment Program?
• § 62.24 — Who is eligible to apply for the Loan Repayment Program?
• § 62.25 — What does the Loan Repayment Program provide?
• § 62.26 — What does an individual have to do in return for loan repayments received under the Loan Repayment Program?
• § 62.27 — What will happen if an individual does not comply with the terms and conditions of participation in the Loan Repayment Program?
• § 62.28 — Under what circumstances can the service or payment obligation be canceled, waived or suspended?
• § 62.29 — Under what circumstances can the Loan Repayment Program obligation be discharged in bankruptcy?
• § 62.30 — What other regulations and statutes apply?
• § 62.51 — What is the scope and purpose of the State Loan Repayment Program?
• § 62.52 — Definitions
• § 62.53 — Who is eligible for this program?
• § 62.54 — What must applications for the State Loan Repayment Program contain?
• § 62.55 — What State Program Elements are required to ensure similarity with the NHSC Loan Repayment Program?
• § 62.56 — How are the Federal grant funds and State matching funds to be used under this program?
• § 62.57 — How will States be selected to participate in this program?
• § 62.58 — What other regulations apply?
• § 62.71 — What is the scope and purpose of the Special Repayment Program?
• § 62.72 — Definitions
• § 62.73 — What are the procedures for participation in the Special Repayment Program?
• § 62.74 — How much credit will a Program participant receive for monetary repayments made, or for approved service performed, before beginning service under the Special Repayment Program?
• § 62.75 — Will individuals serving under the Special Repayment Program receive credit for partial service?
• § 62.76 — How will amounts of money due under the option under section 204(c)(1) of Public Law 100-177 be required to be repaid?

PART 63a

• § 63a.1 — To what programs do these regulations apply?
• § 63a.10 — How may training grant funds be spent?
• § 63a.11 — Other HHS regulations and policies that apply
• § 63a.2 — Definitions
• § 63a.3 — What is the purpose of training grants?
• § 63a.4 — Who is eligible for a training grant?
• § 63a.5 — How to apply for a training grant
• § 63a.6 — How are training grant applications evaluated?
• § 63a.7 — Awards
• § 63a.8 — How long does grant support last?
• § 63a.9 — What are the terms and conditions of awards?

PART 63

• § 63.1 — To what programs do these regulations apply?
• § 63.2 — Definitions
• § 63.3 — What is the purpose of traineeships?
• § 63.4 — What are the minimum qualifications for awards?
• § 63.5 — How will NIH make awards?
• § 63.6 — How to apply
• § 63.7 — What are the benefits of awards?
• § 63.8 — What are the terms and conditions of awards?
• § 63.9 — How may NIH terminate awards?
• § 63.10 — Other HHS regulations and policies that apply

PART 64a

• § 64a.101 — Purpose
• § 64a.102 — To whom do these regulations apply?
• § 64a.103 — Definitions
• § 64a.104 — What requirements are imposed upon grantees?
• § 64a.105 — What are the conditions of obligated service?

PART 64

• § 64.1 — Programs to which these regulations apply
• § 64.2 — Definitions
• § 64.3 — Who is eligible for a grant?
• § 64.4 — How to apply for a grant
• § 64.5 — How are grant applications evaluated?
• § 64.6 — Awards
• § 64.7 — What other conditions apply?
• § 64.8 — How may funds be used?
• § 64.9 — Other HHS regulations that apply

PART 65a

• § 65a.1 — To what programs do these regulations apply?
• § 65a.10 — For what purposes may grant funds be spent?
• § 65a.11 — Other HHS regulations and policies that apply
• § 65a.2 — Definitions
• § 65a.3 — Who is eligible to apply for a grant?
• § 65a.4 — What are the program requirements?
• § 65a.5 — How to apply
• § 65a.6 — How will applications be evaluated?
• § 65a.7 — Awards
• § 65a.8 — How long does grant support last?
• § 65a.9 — What are the terms and conditions of awards?

PART 65

• § 65.1 — To what projects do these regulations apply?
• § 65.2 — Definitions
• § 65.3 — Who is eligible to apply for a grant?
• § 65.4 — Project requirements
• § 65.5 — How will applications be evaluated?
• § 65.6 — How long does grant support last?
• § 65.7 — For what purposes may grant funds be spent?
• § 65.8 — What additional Department regulations apply to grantees?
• § 65.9 — Additional conditions

PART 66

• § 66.101 — Applicability
• § 66.102 — Definitions
• § 66.103 — Eligibility
• § 66.104 — Application
• § 66.105 — Requirements
• § 66.106 — Awards
• § 66.107 — Payments to awardees
• § 66.108 — Payments to institutions
• § 66.109 — Termination
• § 66.110 — Service, payback, and recovery requirements
• § 66.111 — Suspension, waiver, and cancellation
• § 66.112 — Other HHS regulations and policies that apply
• § 66.113 — Publications
• § 66.114 — Copyright
• § 66.115 — Additional conditions
• § 66.201 — Applicability
• § 66.202 — Definitions
• § 66.203 — Eligibility
• § 66.204 — Application
• § 66.205 — Requirements
• § 66.206 — Grant awards
• § 66.207 — Other HHS regulations and policies that apply
• § 66.208 — Additional conditions

PART 67

• § 67.10 — Purpose and scope
• § 67.11 — Definitions
• § 67.12 — Eligible applicants
• § 67.13 — Eligible projects
• § 67.14 — Application
• § 67.15 — Peer review of applications
• § 67.16 — Evaluation and disposition of application
• § 67.17 — Grant award
• § 67.18 — Use of project funds
• § 67.19 — Other applicable regulations
• § 67.20 — Confidentiality
• § 67.21 — Control of data and availability of publications
• § 67.22 — Additional conditions
• § 67.101 — Purpose and scope
• § 67.102 — Definitions
• § 67.103 — Peer review of contract proposals
• § 67.104 — Confidentiality
• § 67.105 — Control of data and availability of publications

PART 68b

• § 68b.1 — What is the scope and purpose of the National Institutes of Health Undergraduate Scholarship Program Regarding Professions Needed by National Research Institutes?
• § 68b.10 — When can a Scholarship Program payment obligation be discharged in bankruptcy?
• § 68b.11 — Under what circumstances can the service or payment obligation be canceled, waived, or suspended?
• § 68b.12 — What other regulations and statutes apply?
• § 68b.2 — Definitions
• § 68b.3 — Who is eligible to apply for a Scholarship Program award?
• § 68b.4 — How is an application made for a Scholarship Program award?
• § 68b.5 — How will applicants be selected to participate in the Scholarship Program?
• § 68b.6 — What will an individual be awarded for participating in the Scholarship Program?
• § 68b.7 — What does an individual have to do in return for the Scholarship Program award?
• § 68b.8 — Under what circumstances can the period of obligated service be deferred to complete approved graduate training?
• § 68b.9 — What will happen if an individual does not comply with the terms and conditions of participating in the Scholarship Program?

PART 68

• § 68.1 — What are the scope and purpose of the NIH LRPs?
• § 68.2 — Definitions
• § 68.3 — Who is eligible to apply?
• § 68.4 — Who is eligible to participate?
• § 68.5 — Who is ineligible to participate?
• § 68.6 — How do individuals apply to participate in the NIH LRPs?
• § 68.7 — How are applicants selected to participate in the NIH LRPs?
• § 68.8 — What do the NIH LRPs provide to participants?
• § 68.9 — What loans qualify for repayment?
• § 68.10 — What loans are ineligible for repayment?
• § 68.11 — What does an individual have to do in return for loan repayments received under the NIH LRPs?
• § 68.12 — How does an individual receive loan repayments beyond the initial applicable contract period?
• § 68.13 — What will happen if an individual does not comply with the terms and conditions of participation in the NIH LRPs?
• § 68.14 — Under what circumstances can the service or payment obligation be canceled, waived, or suspended?
• § 68.15 — When can an NIH LRP payment obligation be discharged in bankruptcy?
• § 68.16 — Additional conditions
• § 68.17 — What other regulations and statutes apply?

PART 70

• § 70.1 — General definitions
• § 70.2 — Measures in the event of inadequate local control
• § 70.3 — All communicable diseases
• § 70.4 — Report of disease
• § 70.5 — Requirements relating to travelers under a Federal order of isolation, quarantine, or conditional release
• § 70.6 — Apprehension and detention of persons with quarantinable communicable diseases
• § 70.7 — Responsibility with respect to minors, wards, and patients
• § 70.8 — Members of military and naval forces
• § 70.9 — Vaccination clinics
• § 70.10 — Public health prevention measures to detect communicable disease
• § 70.11 — Report of death or illness onboard aircraft operated by an airline
• § 70.12 — Medical examinations
• § 70.13 — Payment for care and treatment
• § 70.14 — Requirements relating to the issuance of a Federal order for quarantine, isolation, or conditional release
• § 70.15 — Mandatory reassessment of a Federal order for quarantine, isolation, or conditional release
• § 70.16 — Medical review of a Federal order for quarantine, isolation, or conditional release
• § 70.17 — Administrative records relating to Federal quarantine, isolation, or conditional release
• § 70.18 — Penalties

PART 71

• § 71.1 — Scope and definitions
• § 71.2 — Penalties
• § 71.3 — Designation of yellow fever vaccination centers; Validation stamps
• § 71.4 — Requirements relating to the transmission of airline passenger, crew, and flight information for public health purposes
• § 71.5 — Requirements relating to the transmission of vessel passenger, crew, and voyage information for public health purposes
• § 71.11 — Bills of health
• § 71.20 — Public health prevention measures to detect communicable disease
• § 71.21 — Report of death or illness
• § 71.29 — Administrative records relating to quarantine, isolation, or conditional release
• § 71.30 — Payment for care and treatment
• § 71.31 — General provisions
• § 71.32 — Persons, carriers, and things
• § 71.33 — Persons: Isolation and surveillance
• § 71.34 — Carriers of U.S. military services
• § 71.35 — Report of death or illness on carrier during stay in port
• § 71.36 — Medical examinations
• § 71.37 — Requirements relating to the issuance of a Federal order for quarantine, isolation, or conditional release
• § 71.38 — Mandatory reassessment of a Federal order for quarantine, isolation, or conditional release (surveillance)
• § 71.39 — Medical review of a Federal order for quarantine, isolation, or conditional release
• § 71.40 — Suspension of the right to introduce and prohibition of the introduction of persons into the United States from designated foreign countries or places for public health purposes
• § 71.41 — General provisions
• § 71.42 — Disinfection of imports
• § 71.43 — Exemption for mails
• § 71.44 — Disinsection of aircraft
• § 71.45 — Food, potable water, and waste: U.S. seaports and airports
• § 71.46 — Issuance of Deratting Certificates and Deratting Exemption Certificates
• § 71.47 — Special provisions relating to airports: Office and isolation facilities
• § 71.48 — Carriers in intercoastal and interstate traffic
• § 71.50 — Scope and definitions
• § 71.51 — Dogs and cats
• § 71.52 — Turtles, tortoises, and terrapins
• § 71.53 — Requirements for importers of nonhuman primates
• § 71.54 — Import regulations for infectious biological agents, infectious substances, and vectors
• § 71.55 — Importation of human remains
• § 71.56 — African rodents and other animals that may carry the monkeypox virus
• § 71.63 — Suspension of entry of animals, articles, or things from designated foreign countries and places into the United States

PART 73

• § 73.0 — Applicability and related requirements
• § 73.1 — Definitions
• § 73.2 — Purpose and scope
• § 73.3 — HHS select agents and toxins
• § 73.4 — Overlap select agents and toxins
• § 73.5 — Exemptions for HHS select agents and toxins
• § 73.6 — Exemptions for overlap select agents and toxins
• § 73.7 — Registration and related security risk assessments
• § 73.8 — Denial, revocation, or suspension of registration
• § 73.9 — Responsible Official
• § 73.10 — Restricting access to select agents and toxins; security risk assessments
• § 73.11 — Security
• § 73.12 — Biosafety
• § 73.13 — Restricted experiments
• § 73.14 — Incident response
• § 73.15 — Training
• § 73.16 — Transfers
• § 73.17 — Records
• § 73.18 — Inspections
• § 73.19 — Notification of theft, loss, or release
• § 73.20 — Administrative review
• § 73.21 — Civil money penalties

PART 75

• § 75.1 — Background and purpose
• § 75.2 — Definitions
• § 75.3 — Applicability

PART 81

• § 81.0 — Background
• § 81.1 — Purpose and Authority
• § 81.2 — Provisions of EEOICPA concerning this part
• § 81.4 — Definition of terms used in this part
• § 81.5 — Use of personal and medical information
• § 81.6 — Use of radiation dose information
• § 81.10 — Use of cancer risk assessment models in NIOSH IREP
• § 81.11 — Use of uncertainty analysis in NIOSH-IREP
• § 81.12 — Procedure to update NIOSH-IREP
• § 81.20 — Required use of NIOSH-IREP
• § 81.21 — Cancers requiring the use of NIOSH-IREP
• § 81.22 — General guidelines for use of NIOSH-IREP
• § 81.23 — Guidelines for cancers for which primary site is unknown
• § 81.24 — Guidelines for leukemia
• § 81.25 — Guidelines for claims including two or more primary cancers

PART 82

• § 82.0 — Background information on this part
• § 82.1 — What is the purpose of this part?
• § 82.2 — What are the basics of dose reconstruction?
• § 82.3 — What Are the Requirements for Dose Reconstruction Under EEOICPA?
• § 82.4 — How Will DOL Use the Results of the NIOSH Dose Reconstructions?
• § 82.5 — Definition of terms used in this part
• § 82.10 — Overview of the dose reconstruction process
• § 82.11 — For which claims under EEOICPA will NIOSH conduct a dose reconstruction?
• § 82.12 — Will it be possible to conduct dose reconstructions for all claims?
• § 82.13 — What sources of information may be used for dose reconstructions?
• § 82.14 — What types of information could be used in dose reconstructions?
• § 82.15 — How will NIOSH evaluate the completeness and adequacy of individual monitoring data?
• § 82.16 — How will NIOSH add to monitoring data to remedy limitations of individual monitoring and missed dose?
• § 82.17 — What types of information could be used to supplement or substitute for individual monitoring data?
• § 82.18 — How will NIOSH calculate internal dose to the primary cancer site(s)?
• § 82.19 — How will NIOSH address uncertainty about dose levels?
• § 82.25 — When will NIOSH report dose reconstruction results, and to whom?
• § 82.26 — How will NIOSH report dose reconstruction results?
• § 82.27 — How can claimants obtain reviews of their NIOSH dose reconstruction results by NIOSH?
• § 82.28 — Who can review NIOSH dose reconstruction files on individual claimants?
• § 82.30 — How will NIOSH inform the public of any plans to change scientific elements underlying the dose reconstruction process to maintain methods reasonably current with scientific progress?
• § 82.31 — How can the public recommend changes to scientific elements underlying the dose reconstruction process?
• § 82.32 — How will NIOSH make changes in scientific elements underlying the dose reconstruction process, based on scientific progress?
• § 82.33 — How will NIOSH inform the public of changes to the scientific elements underlying the dose reconstruction process?

PART 83

• § 83.0 — Background information on the procedures in this part
• § 83.1 — What is the purpose of the procedures in this part?
• § 83.2 — How will DOL use the designations established under the procedures in this part?
• § 83.5 — Definitions of terms used in the procedures in this part
• § 83.6 — Overview of the procedures in this part
• § 83.7 — Who can submit a petition on behalf of a class of employees?
• § 83.8 — How is a petition submitted?
• § 83.9 — What information must a petition include?
• § 83.10 — If a petition satisfies all relevant requirements under § 83.9, does this mean the class will be added to the Cohort?
• § 83.11 — What happens to petitions that do not satisfy all relevant requirements under §§ 83.7 through 83.9?
• § 83.12 — How will NIOSH notify petitioners, the Board, and the public of petitions that have been selected for evaluation?
• § 83.13 — How will NIOSH evaluate petitions, other than petitions by claimants covered under § 83.14?
• § 83.14 — How will NIOSH evaluate a petition by a claimant whose dose reconstruction NIOSH could not complete under 42 CFR part 82?
• § 83.15 — How will the Board consider and advise the Secretary on a petition?
• § 83.16 — How will the Secretary decide the outcome(s) of a petition?
• § 83.17 — How will the Secretary report a final decision to add a class of employees to the Cohort and any action of Congress concerning the effect of the final decision?
• § 83.18 — How can petitioners obtain an administrative review of a final decision by the Secretary?
• § 83.19 — How can the Secretary cancel or modify a final decision to add a class of employees to the Cohort?

PART 84

• § 84.1 — Purpose
• § 84.2 — Definitions
• § 84.3 — Respirators for mine rescue or other emergency use in mines
• § 84.10 — Application procedures
• § 84.11 — Contents of application
• § 84.12 — Delivery of respirators and components by applicant; requirements
• § 84.20 — Establishment of fees
• § 84.21 — Fee calculation
• § 84.22 — Fee administration
• § 84.23 — Fee revision
• § 84.24 — Authorization for additional examinations, inspections, tests, and fees
• § 84.30 — Certificates of approval; scope of approval
• § 84.31 — Certificates of approval; contents
• § 84.32 — Notice of disapproval
• § 84.33 — Approval labels and markings; approval of contents; use
• § 84.34 — Revocation of certificates of approval
• § 84.35 — Changes or modifications of approved respirators; issuance of modification of certificate of approval
• § 84.36 — Delivery of changed or modified approved respirator
• § 84.40 — Quality control plans; filing requirements
• § 84.41 — Quality control plans; contents
• § 84.42 — Proposed quality control plans; approval by the Institute
• § 84.43 — Quality control records; review by the Institute; revocation of approval
• § 84.50 — Types of respirators to be approved; scope of approval
• § 84.51 — Entry and escape, or escape only; classification
• § 84.52 — Respiratory hazards; classification
• § 84.53 — Service time; classification
• § 84.60 — Construction and performance requirements; general
• § 84.61 — General construction requirements
• § 84.62 — Component parts; minimum requirements
• § 84.63 — Test requirements; general
• § 84.64 — Pretesting by applicant; approval of test methods
• § 84.65 — Conduct of examinations, inspections, and tests by the Institute; assistance by applicant; observers; recorded data; public demonstrations
• § 84.66 — Withdrawal of applications
• § 84.70 — Self-contained breathing apparatus; description
• § 84.71 — Self-contained breathing apparatus; required components
• § 84.72 — Breathing tubes; minimum requirements
• § 84.73 — Harnesses; installation and construction; minimum requirements
• § 84.74 — Apparatus containers; minimum requirements
• § 84.75 — Half-mask facepieces, full facepieces, mouthpieces; fit; minimum requirements
• § 84.76 — Facepieces; eyepieces; minimum requirements
• § 84.77 — Inhalation and exhalation valves; minimum requirements
• § 84.78 — Head harnesses; minimum requirements
• § 84.79 — Breathing gas; minimum requirements
• § 84.80 — Interchangeability of oxygen and air prohibited
• § 84.81 — Compressed breathing gas and liquefied breathing gas containers; minimum requirements
• § 84.82 — Gas pressure gages; minimum requirements
• § 84.83 — Timers; elapsed time indicators; remaining service life indicators; minimum requirements
• § 84.84 — Hand-operated valves; minimum requirements
• § 84.85 — Breathing bags; minimum requirements
• § 84.86 — Component parts exposed to oxygen pressures; minimum requirements
• § 84.87 — Compressed gas filters; minimum requirements
• § 84.88 — Breathing bag test
• § 84.89 — Weight requirement
• § 84.90 — Breathing resistance test; inhalation
• § 84.91 — Breathing resistance test; exhalation
• § 84.92 — Exhalation valve leakage test
• § 84.93 — Gas flow test; open-circuit apparatus
• § 84.94 — Gas flow test; closed-circuit apparatus
• § 84.95 — Service time test; open-circuit apparatus
• § 84.96 — Service time test; closed-circuit apparatus
• § 84.97 — Test for carbon dioxide in inspired gas; open- and closed-circuit apparatus; maximum allowable limits
• § 84.98 — Tests during low temperature operation
• § 84.99 — Man tests; testing conditions; general requirements
• § 84.100 — Man tests 1, 2, 3, and 4; requirements
• § 84.101 — Man test 5; requirements
• § 84.102 — Man test 6; requirements
• § 84.103 — Man tests; performance requirements
• § 84.104 — Gas tightness test; minimum requirements
• § 84.110 — Gas masks; description
• § 84.111 — Gas masks; required components
• § 84.112 — Canisters and cartridges in parallel; resistance requirements
• § 84.113 — Canisters and cartridges; color and markings; requirements
• § 84.114 — Filters used with canisters and cartridges; location; replacement
• § 84.115 — Breathing tubes; minimum requirements
• § 84.116 — Harnesses; installation and construction; minimum requirements
• § 84.117 — Gas mask containers; minimum requirements
• § 84.118 — Half-mask facepieces, full facepieces, and mouthpieces; fit; minimum requirements
• § 84.119 — Facepieces; eyepieces; minimum requirements
• § 84.120 — Inhalation and exhalation valves; minimum requirements
• § 84.121 — Head harnesses; minimum requirements
• § 84.122 — Breathing resistance test; minimum requirements
• § 84.123 — Exhalation valve leakage test
• § 84.124 — Facepiece tests; minimum requirements
• § 84.125 — Particulate tests; canisters containing particulate filters; minimum requirements
• § 84.126 — Canister bench tests; minimum requirements
• § 84.130 — Supplied-air respirators; description
• § 84.131 — Supplied-air respirators; required components
• § 84.132 — Breathing tubes; minimum requirements
• § 84.133 — Harnesses; installation and construction; minimum requirements
• § 84.134 — Respirator containers; minimum requirements
• § 84.135 — Half-mask facepieces, full facepieces, hoods, and helmets; fit; minimum requirements
• § 84.136 — Facepieces, hoods, and helmets; eyepieces; minimum requirements
• § 84.137 — Inhalation and exhalation valves; check valves; minimum requirements
• § 84.138 — Head harnesses; minimum requirements
• § 84.139 — Head and neck protection; supplied-air respirators; minimum requirements
• § 84.140 — Air velocity and noise levels; hoods and helmets; minimum requirements
• § 84.141 — Breathing gas; minimum requirements
• § 84.142 — Air supply source; hand-operated or motor driven air blowers; Type A supplied-air respirators; minimum requirements
• § 84.143 — Terminal fittings or chambers; Type B supplied-air respirators; minimum requirements
• § 84.144 — Hand-operated blower test; minimum requirements
• § 84.145 — Motor-operated blower test; minimum requirements
• § 84.146 — Method of measuring the power and torque required to operate blowers
• § 84.147 — Type B supplied-air respirator; minimum requirements
• § 84.148 — Type C supplied-air respirator, continuous flow class; minimum requirements
• § 84.149 — Type C supplied-air respirator, demand and pressure demand class; minimum requirements
• § 84.150 — Air-supply line tests; minimum requirements
• § 84.151 — Harness test; minimum requirements
• § 84.152 — Breathing tube test; minimum requirements
• § 84.153 — Airflow resistance test, Type A and Type AE supplied-air respirators; minimum requirements
• § 84.154 — Airflow resistance test; Type B and Type BE supplied-air respirators; minimum requirements
• § 84.155 — Airflow resistance test; Type C supplied-air respirator, continuous flow class and Type CE supplied-air respirator; minimum requirements
• § 84.156 — Airflow resistance test; Type C supplied-air respirator, demand class; minimum requirements
• § 84.157 — Airflow resistance test; Type C supplied-air respirator, pressure-demand class; minimum requirements
• § 84.158 — Exhalation valve leakage test
• § 84.159 — Man tests for gases and vapors; supplied-air respirators; general performance requirements
• § 84.160 — Man test for gases and vapors; Type A and Type AE respirators; test requirements
• § 84.161 — Man test for gases and vapors; Type B and Type BE respirators; test requirements
• § 84.162 — Man test for gases and vapors; Type C respirators, continuous-flow class and Type CE supplied-air respirators; test requirements
• § 84.163 — Man test for gases and vapors; Type C supplied-air respirators, demand and pressure-demand classes; test requirements
• § 84.170 — Air-purifying particulate respirators; description
• § 84.171 — Required components and attributes
• § 84.172 — Airflow resistance test
• § 84.173 — Exhalation valve leakage test
• § 84.174 — Filter efficiency level determination test—non-powered series N, R, and P filtration
• § 84.175 — Instantaneous filter efficiency level determination test—PAPR series HE, PAPR100-N, and PAPR100-P filtration
• § 84.176 — Fit test—PAPR classes HE and PAPR100
• § 84.177 — Total noise level test—PAPR classes HE and PAPR100
• § 84.178 — Breath response type, airflow resistance test—PAPR classes HE and PAPR100
• § 84.179 — Silica dust loading test—PAPR series HE filtration
• § 84.180 — Particulate loading test—PAPR series PAPR100-N and PAPR100-P filtration
• § 84.181 — Communication performance test—PAPR class PAPR100
• § 84.190 — Chemical cartridge respirators: description
• § 84.191 — Chemical cartridge respirators; required components
• § 84.192 — Cartridges in parallel; resistance requirements
• § 84.193 — Cartridges; color and markings; requirements
• § 84.194 — Filters used with chemical cartridges; location; replacement
• § 84.195 — Breathing tubes; minimum requirements
• § 84.196 — Harnesses; installation and construction; minimum requirements
• § 84.197 — Respirator containers; minimum requirements
• § 84.198 — Half-mask facepieces, full facepieces, mouthpieces, hoods, and helmets; fit; minimum requirements
• § 84.199 — Facepieces, hoods, and helmets; eyepieces; minimum requirements
• § 84.200 — Inhalation and exhalation valves; minimum requirements
• § 84.201 — Head harnesses; minimum requirements
• § 84.202 — Air velocity and noise levels; hoods and helmets; minimum requirements
• § 84.203 — Breathing resistance test; minimum requirements
• § 84.204 — Exhalation valve leakage test; minimum requirements
• § 84.205 — Facepiece test; minimum requirements
• § 84.206 — Particulate tests; respirators with filters; minimum requirements; general
• § 84.207 — Bench tests; gas and vapor tests; minimum requirements; general
• § 84.250 — Vinyl chloride respirators; description
• § 84.251 — Required components
• § 84.252 — Gas masks; requirements and tests
• § 84.253 — Chemical-cartridge respirators; requirements and tests
• § 84.254 — Powered air-purifying respirators; requirements and tests
• § 84.255 — Requirements for end-of-service-life indicator
• § 84.256 — Quality control requirements
• § 84.257 — Labeling requirements
• § 84.300 — Closed-circuit escape respirator; description
• § 84.301 — Applicability to new and previously approved CCERs
• § 84.302 — Required components, attributes, and instructions
• § 84.303 — General testing conditions and requirements
• § 84.304 — Capacity test requirements
• § 84.305 — Performance test requirements
• § 84.306 — Wearability test requirements
• § 84.307 — Environmental treatments
• § 84.308 — Additional testing
• § 84.309 — Additional testing and requirements for dockable CCERs
• § 84.310 — Post-approval testing
• § 84.311 — Registration of CCER units upon purchase

PART 85a

• § 85a.1 — Applicability
• § 85a.2 — Definitions
• § 85a.3 — Authority for investigations of places of employment
• § 85a.4 — Procedures for initiating investigations of places of employment
• § 85a.5 — Conduct of investigations of places of employment
• § 85a.6 — Provision of suitable space for employee interviews and examinations
• § 85a.7 — Imminent dangers
• § 85a.8 — Reporting of results of investigations of places of employment

PART 85

• § 85.1 — Applicability
• § 85.2 — Definitions
• § 85.3 — Procedures for requesting health hazard evaluations
• § 85.3-1 — Contents of a request for health hazard evaluation
• § 85.4 — Acting on requests
• § 85.5 — Authority for investigations
• § 85.6 — Advance notice of visits
• § 85.7 — Conduct of investigations
• § 85.8 — Provision of suitable space for employee interviews and examinations; identification of employees
• § 85.9 — Representatives of employers and employees; employee requests
• § 85.10 — Imminent dangers
• § 85.11 — Notification of determination to employers, affected employees and Department of Labor
• § 85.12 — Subsequent requests for health hazard evaluations

PART 86

• § 86.1 — Applicability
• § 86.2 — Definitions
• § 86.3 — Inventions and discoveries
• § 86.4 — Publications and copyrights
• § 86.5 — Grant appeals procedure
• § 86.10 — Nature and purpose of training grants
• § 86.11 — Eligibility
• § 86.12 — Application for a grant
• § 86.13 — Project requirements
• § 86.14 — Evaluation and grant award
• § 86.15 — Payments
• § 86.16 — Use of project funds
• § 86.17 — Nondiscrimination
• § 86.18 — Grantee accountability
• § 86.19 — Human subjects; animal welfare
• § 86.20 — Additional conditions
• § 86.21 — Applicability of 45 CFR part 74
• § 86.30 — Nature and purpose of direct traineeships
• § 86.31 — Eligibility; minimum requirements
• § 86.32 — Application for direct traineeship
• § 86.33 — Human subjects; animal welfare
• § 86.34 — Evaluation and award of direct traineeships
• § 86.35 — Payments
• § 86.36 — Duration and continuation
• § 86.37 — Terms and conditions
• § 86.38 — Accountability
• § 86.39 — Termination of direct traineeship

PART 87

• § 87.1 — To which programs does this regulation apply?
• § 87.2 — Definitions
• § 87.3 — Who is eligible to apply for a grant under this part?
• § 87.4 — For what purposes may grants be awarded?
• § 87.5 — What information must be included in the grant application?
• § 87.6 — How will grant applications be evaluated and the grants awarded?
• § 87.7 — For what period of time will grants be awarded?
• § 87.8 — How may a grantee use grant funds?
• § 87.9 — Which other HHS regulations apply?

PART 88

• § 88.1 — Definitions
• § 88.2 — General provisions
• § 88.3 — Eligibility—currently identified responders
• § 88.4 — Eligibility criteria—WTC responders
• § 88.5 — Application process—WTC responders
• § 88.6 — Enrollment decision—WTC responders
• § 88.7 — Eligibility—currently identified survivors
• § 88.8 — Eligibility criteria—WTC survivors
• § 88.9 — Application process—WTC survivors
• § 88.10 — Enrollment decision—screening-eligible survivors
• § 88.11 — Initial health evaluation for screening-eligible survivors
• § 88.12 — Enrollment decision—certified-eligible survivors
• § 88.13 — Disenrollment
• § 88.14 — Appeal of enrollment or disenrollment decision
• § 88.15 — List of WTC-Related Health Conditions
• § 88.16 — Addition of health conditions to the List of WTC-Related Health Conditions
• § 88.17 — Physician's determination of WTC-related health conditions
• § 88.18 — Certification
• § 88.19 — Decertification
• § 88.20 — Authorization of treatment
• § 88.21 — Appeal of certification, decertification, or treatment authorization decision
• § 88.22 — Reimbursement for medical treatment and services
• § 88.23 — Appeal of reimbursement denial
• § 88.24 — Coordination of benefits and recoupment
• § 88.25 — Reopening of WTC Health Program final decisions

PART 90

• § 90.1 — Purpose and applicability
• § 90.2 — Definitions
• § 90.3 — Procedures for requesting health assessments
• § 90.4 — Contents of requests for health assessments
• § 90.5 — Acting on requests
• § 90.6 — Notification of determination to conduct a health assessment in response to a request from the public
• § 90.7 — Decision to conduct health effects study
• § 90.8 — Conduct of health assessments and health effects studies
• § 90.9 — Public health advisory
• § 90.10 — Notice and comment period
• § 90.11 — Reporting of results of health assessments and health effects studies
• § 90.12 — Confidentiality of information
• § 90.13 — Recordkeeping requirements
• § 90.14 — Documentation and cost recovery

PART 93

• § 93.25 — Organization of this part
• § 93.50 — Special terms
• § 93.75 — Application of effective date to research misconduct proceedings
• § 93.100 — General policy
• § 93.101 — Purpose
• § 93.102 — Applicability
• § 93.103 — Requirements for findings of research misconduct
• § 93.104 — Time limitations
• § 93.105 — Evidentiary standards
• § 93.106 — Confidentiality
• § 93.107 — Coordination with other agencies
• § 93.200 — Accepted practices of the relevant research community
• § 93.201 — Administrative action
• § 93.202 — Administrative record
• § 93.203 — Allegation
• § 93.204 — Assessment
• § 93.205 — Charge letter
• § 93.206 — Complainant
• § 93.207 — Contract
• § 93.208 — Day
• § 93.209 — Departmental Appeals Board or DAB
• § 93.210 — Evidence
• § 93.211 — Fabrication
• § 93.212 — Falsification
• § 93.213 — Funding component
• § 93.214 — Good faith
• § 93.215 — Inquiry
• § 93.216 — Institution
• § 93.217 — Institutional Certifying Official
• § 93.218 — Institutional Deciding Official
• § 93.219 — Institutional member
• § 93.220 — Institutional record
• § 93.221 — Intentionally
• § 93.222 — Investigation
• § 93.223 — Knowingly
• § 93.224 — Notice
• § 93.225 — Office of Research Integrity or ORI
• § 93.226 — Person
• § 93.227 — Plagiarism
• § 93.228 — Preponderance of the evidence
• § 93.229 — Public Health Service or PHS
• § 93.230 — PHS support
• § 93.231 — Recklessly
• § 93.232 — Research
• § 93.233 — Research Integrity Officer or RIO
• § 93.234 — Research misconduct
• § 93.235 — Research misconduct proceeding
• § 93.236 — Research record
• § 93.237 — Respondent
• § 93.238 — Retaliation
• § 93.239 — Secretary or HHS
• § 93.240 — Small institution
• § 93.241 — Suspension and Debarment Official or SDO
• § 93.300 — General responsibilities for compliance
• § 93.301 — Research integrity assurances
• § 93.302 — Maintaining active research integrity assurances
• § 93.303 — Research integrity assurances for small institutions
• § 93.304 — Institutional policies and procedures
• § 93.305 — General conduct of research misconduct proceedings
• § 93.306 — Institutional assessment
• § 93.307 — Institutional inquiry
• § 93.308 — Notice of the results of the inquiry
• § 93.309 — Reporting to ORI on the decision to initiate an investigation
• § 93.310 — Institutional investigation
• § 93.311 — Investigation time limits
• § 93.312 — Opportunity to comment on the draft investigation report
• § 93.313 — Investigation report
• § 93.314 — Decision by the Institutional Deciding Official
• § 93.315 — Institutional appeals
• § 93.316 — Transmittal of the institutional record to ORI
• § 93.317 — Completing the research misconduct process
• § 93.318 — Retention and custody of the institutional record and all sequestered evidence
• § 93.319 — Institutional standards of conduct
• § 93.400 — General statement of ORI authority
• § 93.401 — Interaction with other entities and interim actions
• § 93.402 — ORI allegation assessments
• § 93.403 — ORI review of research misconduct proceedings
• § 93.404 — Findings of research misconduct and proposed HHS administrative actions
• § 93.405 — Notifying the respondent of findings of research misconduct and proposed HHS administrative actions
• § 93.406 — Final HHS actions
• § 93.407 — HHS administrative actions
• § 93.408 — Mitigating and aggravating factors in HHS administrative actions
• § 93.409 — Settlement of research misconduct proceedings
• § 93.410 — Final HHS action with no settlement or finding of research misconduct
• § 93.411 — Final HHS action with a settlement or finding of research misconduct
• § 93.412 — Making decisions on institutional noncompliance
• § 93.413 — ORI compliance actions
• § 93.414 — Notice
• § 93.500 — General policy
• § 93.501 — Notice of appeal
• § 93.502 — Appointment of the Administrative Law Judge
• § 93.503 — Filing of the administrative record
• § 93.504 — Standard of review
• § 93.505 — Rights of the parties
• § 93.506 — Authority of the Administrative Law Judge
• § 93.507 — Ex parte communications
• § 93.508 — Filing, format, and service
• § 93.509 — Filing motions
• § 93.510 — Conferences
• § 93.511 — The Administrative Law Judge's ruling

PART 100

• § 100.1 — Applicability
• § 100.2 — Average cost of a health insurance policy
• § 100.3 — Vaccine injury table

PART 110

• § 110.1 — Purpose
• § 110.2 — Summary of available benefits
• § 110.3 — Definitions
• § 110.10 — Eligible requesters
• § 110.11 — Survivors
• § 110.20 — How to establish a covered injury
• § 110.30 — Benefits available to different categories of requesters under this Program
• § 110.31 — Medical benefits
• § 110.32 — Benefits for lost employment income
• § 110.33 — Death benefits
• § 110.40 — How to obtain forms and instructions
• § 110.41 — How to file a Request Package
• § 110.42 — Deadlines for filing Request Forms
• § 110.43 — Deadlines for submitting documentation
• § 110.44 — Legal or personal representatives of requesters
• § 110.45 — Multiple survivors
• § 110.46 — Amending a Request Package
• § 110.50 — Medical records necessary for the Secretary to determine whether a covered injury was sustained
• § 110.51 — Documentation an injured countermeasure recipient must submit for the Secretary to make a determination of eligibility for Program benefits
• § 110.52 — Documentation a survivor must submit for the Secretary to make a determination of eligibility for death benefits
• § 110.53 — Documentation the executor or administrator of the estate of a deceased injured countermeasure recipient must submit for the Secretary to make a determination of eligibility for benefits to the estate
• § 110.60 — Documentation a requester who is determined to be eligible must submit for the Secretary to make a determination of medical benefits
• § 110.61 — Documentation a requester who is determined to be eligible must submit for the Secretary to make a determination of lost employment income benefits
• § 110.62 — Documentation a requester who is determined to be an eligible survivor must submit for the Secretary to make a determination of death benefits
• § 110.63 — Documentation a legal or personal representative must submit when filing on behalf of a minor or on behalf of an adult who lacks legal capacity to receive payment of benefits
• § 110.70 — Determinations the Secretary must make before benefits can be paid
• § 110.71 — Insufficient documentation for eligibility and benefits determinations
• § 110.72 — Sufficient documentation for eligibility and benefits determinations
• § 110.73 — Approval of benefits
• § 110.74 — Disapproval of benefits
• § 110.80 — Calculation of medical benefits
• § 110.81 — Calculation of benefits for lost employment income
• § 110.82 — Calculation of death benefits
• § 110.83 — Payment of all benefits
• § 110.84 — The Secretary's right to recover benefits paid under this Program from third-party payers
• § 110.90 — Reconsideration of the Secretary's eligibility and benefits determinations
• § 110.91 — Secretary's review authority
• § 110.92 — No additional judicial or administrative review of determinations made under this part
• § 110.100 — Injury Tables

PART 121

• § 121.1 — Applicability
• § 121.2 — Definitions
• § 121.3 — The OPTN
• § 121.4 — OPTN policies: Secretarial review and appeals
• § 121.5 — Listing requirements
• § 121.6 — Organ procurement
• § 121.7 — Identification of organ recipient
• § 121.8 — Allocation of organs
• § 121.9 — Designated transplant program requirements
• § 121.10 — Reviews, evaluation, and enforcement
• § 121.11 — Record maintenance and reporting requirements
• § 121.12 — Advisory Committee on Organ Transplantation
• § 121.13 — Definition of human organ under section 301 of the National Organ Transplant Act of 1984, as amended
• § 121.14 — Reimbursement for living organ donors: incidental non-medical expenses

PART 124

• § 124.1 — Applicability
• § 124.2 — Definitions
• § 124.3 — Eligibility
• § 124.4 — Application
• § 124.5 — Grant evaluation and award
• § 124.6 — Grant payments
• § 124.7 — Use of grant funds
• § 124.8 — Grantee accountability
• § 124.9 — Nondiscrimination
• § 124.10 — Additional conditions
• § 124.11 — Applicability of 2 CFR parts 200 and 300
• § 124.501 — Applicability
• § 124.502 — Definitions
• § 124.503 — Compliance level
• § 124.504 — Notice of availability of uncompensated services
• § 124.505 — Eligibility criteria
• § 124.506 — Allocation of services; plan requirement
• § 124.507 — Written determinations of eligibility
• § 124.508 — Cessation of uncompensated services
• § 124.509 — Reporting requirements
• § 124.510 — Record maintenance requirements
• § 124.511 — Investigation and determination of compliance
• § 124.512 — Enforcement
• § 124.513 — Public facility compliance alternative
• § 124.514 — Compliance alternative for facilities with small annual obligations
• § 124.515 — Compliance alternative for community health centers, migrant health centers and certain National Health Service Corps sites
• § 124.516 — Charitable facility compliance alternative
• § 124.517 — Unrestricted availability compliance alternative for Title VI-assisted facilities
• § 124.518 — Agreements with State agencies
• § 124.601 — Applicability
• § 124.602 — Definitions
• § 124.603 — Provision of services
• § 124.604 — Posted notice
• § 124.605 — Reporting and record maintenance requirements
• § 124.606 — Investigation and enforcement
• § 124.607 — Agreements with State agencies
• § 124.701 — Applicability
• § 124.702 — Definitions
• § 124.703 — Federal right of recovery
• § 124.704 — Notification of sale, transfer, or change of use
• § 124.705 — Amount of recovery
• § 124.706 — Calculation of interest
• § 124.707 — Waiver of recovery where facility is sold or transferred to a proprietary entity
• § 124.708 — Waiver of recovery—good cause for other use of facility
• § 124.709 — Withdrawal of waiver

PART 136a

• § 136a.1 — Purpose of the regulations
• § 136a.10 — Definitions
• § 136a.11 — Services available
• § 136a.12 — Persons to whom health services will be provided
• § 136a.13 — Authorization for contract health services
• § 136a.14 — Reconsideration and appeals
• § 136a.15 — Health Service Delivery Areas
• § 136a.16 — Beneficiary Identification Cards and verification of tribal membership
• § 136a.2 — Administrative instructions
• § 136a.31 — Transition period
• § 136a.32 — Delayed implementation
• § 136a.33 — Grace period
• § 136a.34 — Care and treatment of people losing eligibility
• § 136a.41 — Definitions
• § 136a.42 — Appointment actions
• § 136a.43 — Application procedure for preference eligibility
• § 136a.51 — Applicability
• § 136a.52 — Definitions
• § 136a.53 — General rule
• § 136a.54 — Life of the mother would be endangered
• § 136a.55 — Drugs and devices and termination of ectopic pregnancies
• § 136a.56 — Recordkeeping requirements
• § 136a.57 — Confidentiality
• § 136a.61 — Payor of last resort

PART 136

• § 136.1 — Definitions
• § 136.2 — Purpose of the regulations
• § 136.3 — Administrative instructions
• § 136.11 — Services available
• § 136.12 — Persons to whom services will be provided
• § 136.13 — [Reserved]
• § 136.14 — Care and treatment of ineligible individuals
• § 136.21 — Definitions
• § 136.22 — Establishment of contract health service delivery areas
• § 136.23 — Persons to whom contract health services will be provided
• § 136.24 — Authorization for contract health services
• § 136.25 — Reconsideration and appeals
• § 136.30 — Payment to Medicare-participating hospitals for authorized Contract Health Services
• § 136.31 — Authorization by urban Indian organization
• § 136.32 — Disallowance
• § 136.41 — Definitions
• § 136.42 — Appointment actions
• § 136.43 — Application procedure for preference eligibility
• § 136.61 — Payor of last resort
• § 136.101 — Applicability
• § 136.102 — Definitions
• § 136.103 — Eligibility
• § 136.104 — Application
• § 136.105 — Project elements
• § 136.106 — Grant award and evaluation
• § 136.107 — Use of project funds
• § 136.108 — [Reserved]
• § 136.109 — Availability of appropriations
• § 136.110 — Facilities construction
• § 136.111 — Interest
• § 136.112 — Additional conditions
• § 136.113 — Fair and uniform provision of services
• § 136.114 — Applicability of other Department regulations
• § 136.115 — Rescission of grants
• § 136.116 — Reports
• § 136.117 — Amendment of regulations
• § 136.118 — Effect on existing rights
• § 136.119 — Penalties
• § 136.120 — Use of Indian business concerns
• § 136.121 — Indian preference in training and employment
• § 136.201 — Applicability
• § 136.202 — Definitions
• § 136.203 — Payment for provider and supplier services purchased by Indian health programs
• § 136.204 — Authorization by an urban Indian organization
• § 136.301 — Policy and applicability
• § 136.302 — Definitions
• § 136.303 — Indians applying for scholarships
• § 136.304 — Publication of a list of allied health professions
• § 136.305 — Additional conditions
• § 136.310 — Health professions recruitment grants
• § 136.311 — Eligibility
• § 136.312 — Application
• § 136.313 — Evaluation and grant awards
• § 136.314 — Use of funds
• § 136.315 — Publication of list of grantees and projects
• § 136.316 — Other HHS regulations that apply
• § 136.320 — Preparatory scholarship grants
• § 136.321 — Eligibility
• § 136.322 — Application and selection
• § 136.323 — Scholarship and tuition
• § 136.324 — Availability of list of recipients
• § 136.330 — Indian health scholarships
• § 136.331 — Selection
• § 136.332 — Service obligation
• § 136.333 — Distribution of scholarships
• § 136.334 — Publication of a list of recipients
• § 136.340 — Provision of continuing education allowances
• § 136.350 — Contracts with Urban Indian organizations
• § 136.351 — Application and selection
• § 136.352 — Fair and uniform provision of services
• § 136.353 — Reports and records
• § 136.360 — Leases with Indian tribes
• § 136.370 — Pregraduate scholarship grants
• § 136.371 — Eligibility
• § 136.372 — Application and selection
• § 136.373 — Scholarship and tuition
• § 136.374 — Availability of list of recipients
• § 136.401 — Purpose
• § 136.402 — Policy
• § 136.403 — Definitions
• § 136.404 — What does the Indian Child Protection and Family Violence Prevention Act require of the IHS and Indian Tribes or Tribal organizations receiving funds under the ISDEA?
• § 136.405 — What are the minimum standards of character for individuals placed in, or applying for, a position that involves regular contact with or control over Indian children?
• § 136.406 — Under what circumstances will the minimum standards of character be considered to be met?
• § 136.407 — Under what circumstances should a conviction, or plea of nolo contendere or guilty to, be considered if there has been a pardon, expungement, set aside, or other court order of the conviction or plea?
• § 136.408 — What are other factors, in addition to the minimum standards of character, that may be considered in determining placement of an individual in a position that involves regular contact with or control over Indian children?
• § 136.409 — What positions require a background investigation and determination of eligibility for employment or retention?
• § 136.410 — Who conducts the background investigation and prepares determinations of eligibility for employment?
• § 136.411 — Are the requirements for IHS adjudication different from the requirements for Indian Tribes and Tribal organizations?
• § 136.412 — What questions must the IHS ask as part of the background investigation?
• § 136.413 — What protections must the IHS and Tribes or Tribal organizations provide to individuals undergoing a background investigation?
• § 136.414 — How does the IHS determine eligibility for placement or retention of individuals in positions involving regular contact with Indian children?
• § 136.415 — What rights does an individual have during this process?
• § 136.416 — When should the IHS deny employment or dismiss an employee?
• § 136.417 — May the IHS hire individuals pending completion of a background investigation?
• § 136.418 — What should the IHS do if an individual has been charged with an offense but the charge is pending or no disposition has been made by a court?
• § 136.501 — Definitions
• § 136.502 — Purpose of this subpart
• § 136.503 — Threshold cost
• § 136.504 — Reimbursement procedure
• § 136.505 — Reimbursable services
• § 136.506 — Alternate resources
• § 136.507 — Program integrity
• § 136.508 — Recovery of reimbursement funds
• § 136.509 — Reconsideration and appeals
• § 136.510 — Severability

PART 137

• § 137.1 — Authority, purpose and scope
• § 137.2 — Congressional policy
• § 137.3 — Effect on existing Tribal rights
• § 137.4 — May Title V be construed to limit or reduce in any way the funding for any program, project, or activity serving an Indian Tribe under this or other applicable Federal law?
• § 137.5 — Effect of these regulations on Federal program guidelines, manual, or policy directives
• § 137.6 — Secretarial policy
• § 137.10 — Definitions
• § 137.15 — Who may participate in Tribal Self-Governance?
• § 137.16 — What if more than 50 Indian Tribes apply to participate in self-governance?
• § 137.17 — May more than one Indian Tribe participate in the same compact and/or funding agreement?
• § 137.18 — What criteria must an Indian Tribe satisfy to be eligible to participate in self-governance?
• § 137.20 — What is required during the planning phase?
• § 137.21 — How does an Indian Tribe demonstrate financial stability and financial management capacity?
• § 137.22 — May the Secretary consider uncorrected significant and material audit exceptions identified regarding centralized financial and administrative functions?
• § 137.23 — For purposes of determining eligibility for participation in self-governance, may the Secretary consider any other information regarding the Indian Tribe's financial stability and financial management capacity?
• § 137.24 — Are there grants available to assist the Indian Tribe to meet the requirements to participate in self-governance?
• § 137.25 — Are planning and negotiation grants available?
• § 137.26 — Must an Indian Tribe receive a planning or negotiation grant to be eligible to participate in self-governance?
• § 137.30 — What is a self-governance compact?
• § 137.31 — What is included in a compact?
• § 137.32 — Is a compact required to participate in self-governance?
• § 137.33 — May an Indian Tribe negotiate a funding agreement at the same time it is negotiating a compact?
• § 137.34 — May a funding agreement be executed without negotiating a compact?
• § 137.35 — What is the term of a self-governance compact?
• § 137.40 — What is a funding agreement?
• § 137.41 — What PSFAs must be included in a funding agreement?
• § 137.42 — What Tribal shares may be included in a funding agreement?
• § 137.43 — May a Tribe negotiate and leave funds with IHS for retained services?
• § 137.45 — What terms must be included in a funding agreement?
• § 137.46 — May additional terms be included in a funding agreement?
• § 137.47 — Do any provisions of Title I apply to compacts, funding agreements, and construction project agreements negotiated under Title V of the Act?
• § 137.48 — What is the effect of incorporating a Title I provision into a compact or funding agreement?
• § 137.49 — What if a Self-Governance Tribe requests such incorporation at the negotiation stage of a compact or funding agreement?
• § 137.55 — What is the term of a funding agreement?
• § 137.56 — Does a funding agreement remain in effect after the end of its term?
• § 137.57 — How is a funding agreement amended during the effective period of the funding agreement?
• § 137.60 — May a statutorily mandated grant be added to a funding agreement?
• § 137.65 — May a Self-Governance Tribe receive statutorily mandated grant funding in an annual lump sum advance payment?
• § 137.66 — May a Self-Governance Tribe keep interest earned on statutorily mandated grant funds?
• § 137.67 — How may a Self-Governance Tribe use interest earned on statutorily mandated grant funds?
• § 137.68 — May funds from a statutorily mandated grant added to a funding agreement be reallocated?
• § 137.69 — May a statutorily mandated grant program added to a funding agreement be redesigned?
• § 137.70 — Are the reporting requirements different for a statutorily mandated grant program added to a funding agreement?
• § 137.71 — May the Secretary and the Self-Governance Tribe develop separate programmatic reporting requirements for statutorily mandated grants?
• § 137.72 — Are Self-Governance Tribes and their employees carrying out statutorily mandated grant programs added to a funding agreement covered by the Federal Tort Claims Act (FTCA)?
• § 137.73 — What provisions of Title V apply to statutorily mandated grants added to the funding agreement?
• § 137.75 — What funds must the Secretary transfer to a Self-Governance Tribe in a funding agreement?
• § 137.76 — When must the Secretary transfer to a Self-Governance Tribe funds identified in a funding agreement?
• § 137.77 — When must the Secretary transfer funds that were not paid as part of the initial lump sum payment?
• § 137.78 — May a Self-Governance Tribe negotiate a funding agreement for a term longer or shorter than one year?
• § 137.79 — What funds must the Secretary include in a funding agreement?
• § 137.85 — Is the Secretary prohibited from failing or refusing to transfer funds that are due to a Self-Governance Tribe under Title V?
• § 137.86 — Is the Secretary prohibited from reducing the amount of funds required under Title V to make funding available for self-governance monitoring or administration by the Secretary?
• § 137.87 — May the Secretary reduce the amount of funds due under Title V in subsequent years?
• § 137.88 — May the Secretary reduce the amount of funds required under Title V to pay for Federal functions, including Federal pay costs, Federal employee retirement benefits, automated data processing, technical assistance, and monitoring of activities under the Act?
• § 137.89 — May the Secretary reduce the amount of funds required under Title V to pay for costs of Federal personnel displaced by contracts under Title I or Self-Governance under Title V?
• § 137.90 — May the Secretary increase the funds required under the funding agreement?
• § 137.95 — May a Self-Governance Tribe purchase goods and services from the IHS on a reimbursable basis?
• § 137.96 — Does the Prompt Payment Act apply to funds transferred to a Self-Governance Tribe in a compact or funding agreement?
• § 137.100 — May a Self-Governance Tribe retain and spend interest earned on any funds paid under a compact or funding agreement?
• § 137.101 — What standard applies to a Self-Governance Tribe's management of funds paid under a compact or funding agreement?
• § 137.105 — May a Self-Governance Tribe carryover from one year to the next any funds that remain at the end of the funding agreement?
• § 137.110 — May a Self-Governance Tribe retain and expend any program income earned pursuant to a compact and funding agreement?
• § 137.115 — Is a Self-Governance Tribe obligated to continue performance under a compact or funding agreement if the Secretary does not transfer sufficient funds?
• § 137.120 — May a Self-Governance Tribe's funding agreement provide for a stable base budget?
• § 137.121 — What funds may be included in a stable base budget amount?
• § 137.122 — May a Self-Governance Tribe with a stable base budget receive other funding under its funding agreement?
• § 137.123 — Once stable base funding is negotiated, do funding amounts change from year to year?
• § 137.124 — Does the effective period of a stable base budget have to be the same as the term of the funding agreement?
• § 137.130 — What is covered by this subpart?
• § 137.131 — When should a final offer be submitted?
• § 137.132 — How does the Indian Tribe submit a final offer?
• § 137.133 — What does a final offer contain?
• § 137.134 — When does the 45 day review period begin?
• § 137.135 — May the Secretary request and obtain an extension of time of the 45 day review period?
• § 137.136 — What happens if the agency takes no action within the 45 day review period (or any extensions thereof)?
• § 137.137 — If the 45 day review period or extension thereto, has expired, and the Tribes offer is deemed accepted by operation of law, are there any exceptions to this rule?
• § 137.138 — Once the Indian Tribe's final offer has been accepted or deemed accepted by operation of law, what is the next step?
• § 137.140 — On what basis may the Secretary reject an Indian Tribe's final offer?
• § 137.141 — How does the Secretary reject a final offer?
• § 137.142 — What is a “significant danger” or “risk” to the public health?
• § 137.143 — How is the funding level to which the Indian Tribe is entitled determined?
• § 137.144 — Is technical assistance available to an Indian Tribe to avoid rejection of a final offer?
• § 137.145 — If the Secretary rejects a final offer, is the Secretary required to provide the Indian Tribe with technical assistance?
• § 137.146 — If the Secretary rejects all or part of a final offer, is the Indian Tribe entitled to an appeal?
• § 137.147 — Do those portions of the compact, funding agreement, or amendment not in dispute go into effect?
• § 137.148 — Does appealing the decision of the Secretary prevent entering into the compact, funding agreement, or amendment?
• § 137.150 — What is the burden of proof in an appeal from rejection of a final offer?
• § 137.155 — What constitutes a final agency action?
• § 137.160 — Are Self-Governance Tribes required to address potential conflicts of interest?
• § 137.165 — Are Self-Governance Tribes required to undertake annual audits?
• § 137.166 — Are there exceptions to the annual audit requirements?
• § 137.167 — What cost principles must a Self-Governance Tribe follow when participating in self-governance under Title V?
• § 137.168 — May the Secretary require audit or accounting standards other than those specified in § 137.167?
• § 137.169 — How much time does the Federal Government have to make a claim against a Self-Governance Tribe relating to any disallowance of costs, based on an audit conducted under § 137.165?
• § 137.170 — When does the 365 day period commence?
• § 137.171 — Where do Self-Governance Tribes send their audit reports?
• § 137.172 — Should the audit report be sent anywhere else to ensure receipt by the Secretary?
• § 137.173 — Does a Self-Governance Tribe have a right of appeal from a disallowance?
• § 137.175 — Is a Self-Governance Tribe required to maintain a recordkeeping system?
• § 137.176 — Are Tribal records subject to the Freedom of Information Act and Federal Privacy Act?
• § 137.177 — Is the Self-Governance Tribe required to make its records available to the Secretary?
• § 137.178 — May Self-Governance Tribes store patient records at the Federal Records Centers?
• § 137.179 — May a Self-Governance Tribe make agreements with the Federal Records Centers regarding disclosure and release of the patient records stored pursuant to § 137.178?
• § 137.180 — Are there other laws that govern access to patient records?
• § 137.185 — May a Self-Governance Tribe redesign or consolidate the PSFAs that are included in a funding agreement and reallocate or redirect funds for such PSFAs?
• § 137.190 — Is a Self-Governance Tribe that receives funds under Title V also entitled to contract under section 102 of the Act [25 U.S.C. 450(f)] for such funds?
• § 137.200 — Are there reporting requirements for Self-Governance Tribes under Title V?
• § 137.201 — What are the purposes of the Tribal reporting requirements?
• § 137.202 — What types of information will Self-Governance Tribes be expected to include in the reports?
• § 137.203 — May a Self-Governance Tribe participate in a voluntary national uniform data collection effort with the IHS?
• § 137.204 — How will this voluntary national uniform data set be developed?
• § 137.205 — Will this voluntary uniform data set reporting activity be required of all Self-Governance Tribes entering into a compact with the IHS under Title V?
• § 137.206 — Why does the IHS need this information?
• § 137.207 — Will funding be provided to the Self-Governance Tribe to compensate for the costs of reporting?
• § 137.210 — What happens if self-governance activities under Title V reduce the administrative or other responsibilities of the Secretary with respect to the operation of Indian programs and result in savings?
• § 137.211 — How does a Self-Governance Tribe learn whether self-governance activities have resulted in savings as described in § 137.210
• § 137.215 — How does a Self-Governance Tribe obtain title to real and personal property furnished by the Federal Government for use in the performance of a compact, funding agreement, construction project agreement, or grant agreement pursuant to section 512(c) of the Act [25 U.S.C. 458aaa-11(c)]?
• § 137.217 — May funds provided under compacts, funding agreements, or grants made pursuant to Title V be treated as non-Federal funds for purposes of meeting matching or cost participation requirements under any other Federal or non-Federal program?
• § 137.220 — Do section 314 of Public Law 101-512 [25 U.S.C. 450f note] and section 102(d) of the Act [25 U.S.C. 450f(d)] (regarding, in part, FTCA coverage) apply to compacts, funding agreements and construction project agreements?
• § 137.225 — What regulations may be waived under Title V?
• § 137.226 — How does a Self-Governance Tribe request a waiver?
• § 137.227 — How much time does the Secretary have to act on a waiver request?
• § 137.228 — Upon what basis may the waiver request be denied?
• § 137.229 — What happens if the Secretary neither approves or denies a waiver request within the time specified in § 137.227?
• § 137.230 — Is the Secretary's decision on a waiver request final for the Department?
• § 137.231 — May a Self-Governance Tribe appeal the Secretary's decision to deny its request for a waiver of a regulation promulgated under section 517 of the Act [25 U.S.C. 458aaa-16]?
• § 137.235 — May an Indian Tribe withdraw from a participating inter-Tribal consortium or Tribal organization?
• § 137.236 — When does a withdrawal become effective?
• § 137.237 — How are funds redistributed when an Indian Tribe fully or partially withdraws from a compact or funding agreement and elects to enter a contract or compact?
• § 137.238 — How are funds distributed when an Indian Tribe fully or partially withdraws from a compact or funding agreement administered by an inter-Tribal consortium or Tribal organization serving more than one Indian Tribe and the withdrawing Indian Tribe elects not to enter a contract or compact?
• § 137.239 — If the withdrawing Indian Tribe elects to operate PSFAs carried out under a compact or funding agreement under Title V through a contract under Title I, is the resulting contract considered a mature contract under section 4(h) of the Act [25 U.S.C. 450b(h)]?
• § 137.245 — What is retrocession?
• § 137.246 — How does a Self-Governance Tribe retrocede a PSFA?
• § 137.247 — What is the effective date of a retrocession?
• § 137.248 — What effect will a retrocession have on a retroceding Self-Governance Tribe's rights to contract or compact under the Act?
• § 137.249 — Will retrocession adversely affect funding available for the retroceded program?
• § 137.250 — How are funds distributed when a Self-Governance Tribe fully or partially retrocedes from its compact or funding agreement?
• § 137.251 — What obligation does the retroceding Self-Governance Tribe have with respect to returning property that was provided by the Secretary under the compact or funding agreement and that was used in the operation of the retroceded program?
• § 137.255 — What does reassumption mean?
• § 137.256 — Under what circumstances may the Secretary reassume a program, service, function, or activity (or portion thereof)?
• § 137.257 — What steps must the Secretary take prior to reassumption becoming effective?
• § 137.258 — Does the Self-Governance Tribe have a right to a hearing prior to a non-immediate reassumption becoming effective?
• § 137.259 — What happens if the Secretary determines that the Self-Governance Tribe has not corrected the conditions that the Secretary identified in the notice?
• § 137.260 — What is the earliest date on which a reassumption can be effective?
• § 137.261 — Does the Secretary have the authority to immediately reassume a PSFA?
• § 137.262 — If the Secretary reassumes a PSFA immediately, when must the Secretary provide the Self-Governance Tribe with a hearing?
• § 137.263 — May the Secretary provide a grant to a Self-Governance Tribe for technical assistance to overcome conditions identified under § 137.257?
• § 137.264 — To what extent may the Secretary require the Self-Governance Tribe to return property that was provided by the Secretary under the compact or funding agreement and used in the operation of the reassumed program?
• § 137.265 — May a Tribe be reimbursed for actual and reasonable close out costs incurred after the effective date of reassumption?
• § 137.270 — What is covered by this subpart?
• § 137.271 — Why is there a separate subpart in these regulations for construction project agreements?
• § 137.272 — What other alternatives are available for Self-Governance Tribes to perform construction projects?
• § 137.273 — What are IHS construction PSFAs?
• § 137.274 — Does this subpart cover construction programs?
• § 137.275 — May Self-Governance Tribes include IHS construction programs in a construction project agreement or in a funding agreement?
• § 137.280 — Construction Definitions
• § 137.285 — Are Self-Governance Tribes required to accept Federal environmental responsibilities to enter into a construction project agreement?
• § 137.286 — Do Self-Governance Tribes become Federal agencies when they assume these Federal environmental responsibilities?
• § 137.287 — What is the National Environmental Policy Act (NEPA)?
• § 137.288 — What is the National Historic Preservation Act (NHPA)?
• § 137.289 — What is a Federal undertaking under NHPA?
• § 137.290 — What additional provisions of law are related to NEPA and NHPA?
• § 137.291 — May Self-Governance Tribes carry out construction projects without assuming these Federal environmental responsibilities?
• § 137.292 — How do Self-Governance Tribes assume environmental responsibilities for construction projects under section 509 of the Act [25 U.S.C. 458aaa-8]?
• § 137.293 — Are Self-Governance Tribes required to adopt a separate resolution or take equivalent Tribal action to assume environmental responsibilities for each construction project agreement?
• § 137.294 — What is the typical IHS environmental review process for construction projects?
• § 137.295 — May Self-Governance Tribes elect to develop their own environmental review process?
• § 137.296 — How does a Self-Governance Tribe comply with NEPA and NHPA?
• § 137.297 — If the environmental review procedures of a Federal agency are adopted by a Self-Governance Tribe, is the Self-Governance Tribe responsible for ensuring the agency's policies and procedures meet the requirements of NEPA, NHPA, and related environmental laws?
• § 137.298 — Are Self-Governance Tribes required to comply with Executive Orders to fulfill their environmental responsibilities under section 509 of the Act [25 U.S.C. 458aaa-8]?
• § 137.299 — Are Federal funds available to cover the cost of Self-Governance Tribes carrying out environmental responsibilities?
• § 137.300 — Since Federal environmental responsibilities are new responsibilities, which may be assumed by Tribes under section 509 of the Act [25 U.S.C. 458aaa-8], are there additional funds available to Self-Governance Tribes to carry out these formerly inherently Federal responsibilities?
• § 137.301 — How are project and program environmental review costs identified?
• § 137.302 — Are Federal funds available to cover start-up costs associated with initial Tribal assumption of environmental responsibilities?
• § 137.303 — Are Federal or other funds available for training associated with Tribal assumption of environmental responsibilities?
• § 137.304 — May Self-Governance Tribes buy back environmental services from the IHS?
• § 137.305 — May Self-Governance Tribes act as lead, cooperating, or joint lead agencies for environmental review purposes?
• § 137.306 — How are Self-Governance Tribes recognized as having lead, cooperating, or joint lead agency status?
• § 137.307 — What Federal environmental responsibilities remain with the Secretary when a Self-Governance Tribe assumes Federal environmental responsibilities for construction projects under section 509 of the Act [25 U.S.C. 458aaa-8]?
• § 137.308 — Does the Secretary have any enforcement authority for Federal environmental responsibilities assumed by Tribes under section 509 of the Act [25 U.S.C. 458aaa-8]?
• § 137.309 — How are NEPA and NHPA obligations typically enforced?
• § 137.310 — Are Self-Governance Tribes required to grant a limited waiver of their sovereign immunity to assume Federal environmental responsibilities under section 509 of the Act [25 U.S.C. 458aaa-8]?
• § 137.311 — Are Self-Governance Tribes entitled to determine the nature and scope of the limited immunity waiver required under section 509(a)(2) of the Act [25 U.S.C. 458aaa-8(a)(2)]?
• § 137.312 — Who is the proper defendant in a civil enforcement action under section 509(a)(2) of the Act [25 U.S.C. 458aaa-8(a)(2)]?
• § 137.320 — Is the Secretary required to consult with affected Indian Tribes concerning construction projects and programs?
• § 137.321 — How do Indian Tribes and the Secretary identify and request funds for needed construction projects?
• § 137.322 — Is the Secretary required to notify an Indian Tribe that funds are available for a construction project or a phase of a project?
• § 137.325 — What does a Self-Governance Tribe do if it wants to perform a construction project under section 509 of the Act [25 U.S.C. 458aaa-8]?
• § 137.326 — What must a Tribal proposal for a construction project agreement contain?
• § 137.327 — May multiple projects be included in a single construction project agreement?
• § 137.328 — Must a construction project proposal incorporate provisions of Federal construction guidelines and manuals?
• § 137.329 — What environmental considerations must be included in the construction project agreement?
• § 137.330 — What happens if the Self-Governance Tribe and the Secretary cannot develop a mutually agreeable construction project agreement?
• § 137.331 — May the Secretary reject a final construction project proposal based on a determination of Tribal capacity or capability?
• § 137.332 — On what basis may the Secretary reject a final construction project proposal?
• § 137.333 — What procedures must the Secretary follow if the Secretary rejects a final construction project proposal, in whole or in part?
• § 137.334 — What happens if the Secretary fails to notify the Self-Governance Tribe of a decision to approve or reject a final construction project proposal within the time period allowed?
• § 137.335 — What costs may be included in the budget for a construction agreement?
• § 137.336 — What is the difference between fixed-price and cost-reimbursement agreements?
• § 137.337 — What funding must the Secretary provide in a construction project agreement?
• § 137.338 — Must funds from other sources be incorporated into a construction project agreement?
• § 137.339 — May a Self-Governance Tribe use project funds for matching or cost participation requirements under other Federal and non-Federal programs?
• § 137.340 — May a Self-Governance Tribe contribute funding to a project?
• § 137.341 — How will a Self-Governance Tribe receive payment under a construction project agreement?
• § 137.342 — What happens to funds remaining at the conclusion of a cost reimbursement construction project?
• § 137.343 — What happens to funds remaining at the conclusion of a fixed price construction project?
• § 137.344 — May a Self-Governance Tribe reallocate funds among construction project agreements?
• § 137.350 — Is a Self-Governance Tribe responsible for completing a construction project in accordance with the negotiated construction project agreement?
• § 137.351 — Is a Self-Governance Tribe required to submit construction project progress and financial reports for construction project agreements?
• § 137.352 — What is contained in a construction project progress report?
• § 137.353 — What is contained in a construction project financial report?
• § 137.360 — Does the Secretary approve project planning and design documents prepared by the Self-Governance Tribe?
• § 137.361 — Does the Secretary have any other opportunities to approve planning or design documents prepared by the Self-Governance Tribe?
• § 137.362 — May construction project agreements be amended?
• § 137.363 — What is the procedure for the Secretary's review and approval of amendments?
• § 137.364 — What constitutes a significant change in the original scope of work?
• § 137.365 — What is the procedure for the Secretary's review and approval of project planning and design documents submitted by the Self-Governance Tribe?
• § 137.366 — May the Secretary conduct onsite project oversight visits?
• § 137.367 — May the Secretary issue a stop work order under a construction project agreement?
• § 137.368 — Is the Secretary responsible for oversight and compliance of health and safety codes during construction projects being performed by a Self-Governance Tribe under section 509 of the Act [25 U.S.C. 488aaa-8]?
• § 137.370 — Do all provisions of this part apply to construction project agreements under this subpart?
• § 137.371 — Who takes title to real property purchased with funds provided under a construction project agreement?
• § 137.372 — Does the Secretary have a role in the fee-to-trust process when real property is purchased with construction project agreement funds?
• § 137.373 — Do Federal real property laws, regulations and procedures that apply to the Secretary also apply to Self-Governance Tribes that purchase real property with funds provided under a construction project agreement?
• § 137.374 — Does the Secretary have a role in reviewing or monitoring a Self-Governance Tribe's actions in acquiring or leasing real property with funds provided under a construction project agreement?
• § 137.375 — Are Tribally-owned facilities constructed under section 509 of the Act [25 U.S.C. 458aaa-8] eligible for replacement, maintenance, and improvement funds on the same basis as if title to such property were vested in the United States?
• § 137.376 — Are design and construction projects performed by Self-Governance Tribes under section 509 of the Act [25 U.S.C. 458aaa-8] subject to Federal metric requirements?
• § 137.377 — Do Federal procurement laws and regulations apply to construction project agreements performed under section 509 of the Act [25 U.S.C. 458aaa-8]?
• § 137.378 — Do the Federal Davis-Bacon Act and wage rates apply to construction projects performed by Self-Governance Tribes using their own funds or other non-Federal funds?
• § 137.379 — Do Davis-Bacon wage rates apply to construction projects performed by Self-Governance Tribes using Federal funds?
• § 137.401 — What role does Tribal consultation play in the IHS annual budget request process?
• § 137.405 — Is the Secretary required to report to Congress on administration of Title V and the funding requirements presently funded or unfunded?
• § 137.406 — In compiling reports pursuant to this section, may the Secretary impose any reporting requirements on Self-Governance Tribes, not otherwise provided in Title V?
• § 137.407 — What guidelines will be used by the Secretary to compile information required for the report?
• § 137.410 — For the purposes of section 110 of the Act [25 U.S.C. 450m-1] does the term contract include compacts, funding agreements, and construction project agreements entered into under Title V?
• § 137.412 — Do the regulations at 25 CFR Part 900, Subpart N apply to compacts, funding agreements, and construction project agreements entered into under Title V?
• § 137.415 — What decisions may an Indian Tribe appeal under § 137.415 through 137.436?
• § 137.416 — Do §§ 137.415 through 137.436 apply to any other disputes?
• § 137.417 — What procedures apply to Interior Board of Indian Appeals (IBIA) proceedings?
• § 137.418 — How does an Indian Tribe know where and when to file its appeal from decisions made by IHS?
• § 137.419 — What authority does the IBIA have under §§ 137.415 through 137.436?
• § 137.420 — Does an Indian Tribe have any options besides an appeal?
• § 137.421 — How does an Indian Tribe request an informal conference?
• § 137.422 — How is an informal conference held?
• § 137.423 — What happens after the informal conference?
• § 137.424 — Is the recommended decision from the informal conference final for the Secretary?
• § 137.425 — How does an Indian Tribe appeal the initial decision if it does not request an informal conference or if it does not agree with the recommended decision resulting from the informal conference?
• § 137.426 — May an Indian Tribe get an extension of time to file a notice of appeal?
• § 137.427 — What happens after an Indian Tribe files an appeal?
• § 137.428 — How is a hearing arranged?
• § 137.429 — What happens when a hearing is necessary?
• § 137.430 — What is the Secretary's burden of proof for appeals covered by § 137.415?
• § 137.431 — What rights do Indian Tribes and the Secretary have during the appeal process?
• § 137.432 — What happens after the hearing?
• § 137.433 — Is the recommended decision always final?
• § 137.434 — If an Indian Tribe objects to the recommended decision, what will the Secretary do?
• § 137.435 — Will an appeal adversely affect the Indian Tribe's rights in other compact, funding negotiations, or construction project agreement?
• § 137.436 — Will the decisions on appeal be available for the public to review?
• § 137.440 — What happens in the case of an immediate reassumption under section 507(a)(2)(C) of the Act [25 U.S.C. 458aaa-6(a)(2)(C)]?
• § 137.441 — Will there be a hearing?
• § 137.442 — What happens after the hearing?
• § 137.443 — Is the recommended decision always final?
• § 137.444 — If a Self-Governance Tribe objects to the recommended decision, what action will the Secretary take?
• § 137.445 — Will an immediate reassumption appeal adversely affect the Self-Governance Tribe's rights in other self-governance negotiations?
• § 137.450 — Does the Equal Access to Justice Act (EAJA) apply to appeals under this subpart?

PART 400

• § 400.200 — General definitions
• § 400.202 — Definitions specific to Medicare
• § 400.203 — Definitions specific to Medicaid

PART 401

• § 401.101 — Purpose and scope
• § 401.102 — Definitions
• § 401.105 — Rules for disclosure
• § 401.106 — Publication
• § 401.108 — CMS rulings
• § 401.109 — Precedential Final Decisions of the Secretary
• § 401.110 — Publications for sale
• § 401.112 — Availability of administrative staff manuals
• § 401.116 — Availability of records upon request
• § 401.118 — Deletion of identifying details
• § 401.120 — Creation of records
• § 401.126 — Information or records that are not available
• § 401.128 — Where requests for records may be made
• § 401.130 — Materials available at social security district offices and branch offices
• § 401.132 — Materials in field offices of the Office of Hearings and Appeals, SSA
• § 401.133 — Availability of official reports on providers and suppliers of services, State agencies, intermediaries, and carriers under Medicare
• § 401.134 — Release of Medicare information to State and Federal agencies
• § 401.135 — Release of Medicare information to the public
• § 401.136 — Requests for information or records
• § 401.140 — Fees and charges
• § 401.144 — Denial of requests
• § 401.148 — Administrative review
• § 401.152 — Court review
• § 401.301 — Basis and scope
• § 401.303 — Definitions
• § 401.305 — Requirements for reporting and returning of overpayments
• § 401.601 — Basis and scope
• § 401.603 — Definitions
• § 401.605 — Omissions not a defense
• § 401.607 — Claims collection
• § 401.613 — Compromise of claims
• § 401.615 — Payment of compromise amount
• § 401.617 — Suspension of collection action
• § 401.621 — Termination of collection action
• § 401.623 — Joint and several liability
• § 401.625 — Effect of CMS claims collection decisions on appeals
• § 401.701 — Purpose and scope
• § 401.703 — Definitions
• § 401.705 — Eligibility criteria for qualified entities
• § 401.707 — Operating and governance requirements for qualified entities
• § 401.709 — The application process and requirements
• § 401.711 — Updates to plans submitted as part of the application process
• § 401.713 — Ensuring the privacy and security of data
• § 401.715 — Selection and use of performance measures
• § 401.716 — Non-public analyses
• § 401.717 — Provider and supplier requests for error correction
• § 401.718 — Dissemination of data
• § 401.719 — Monitoring and sanctioning of qualified entities
• § 401.721 — Terminating an agreement with a qualified entity
• § 401.722 — Qualified clinical data registries

PART 402

• § 402.1 — Basis and scope
• § 402.3 — Definitions
• § 402.5 — Right to a hearing before the final determination
• § 402.7 — Notice of proposed determination
• § 402.9 — Failure to request a hearing
• § 402.11 — Notice to other agencies and other entities
• § 402.13 — Penalty, assessment, and exclusion not exclusive
• § 402.15 — Collateral estoppel
• § 402.17 — Settlement
• § 402.19 — Hearings and appeals
• § 402.21 — Judicial review
• § 402.105 — Amount of penalty
• § 402.107 — Amount of assessment
• § 402.109 — Statistical sampling
• § 402.111 — Factors considered in determinations regarding the amount of penalties and assessments
• § 402.113 — When a penalty and assessment are collectible
• § 402.115 — Collection of penalty or assessment
• § 402.200 — Basis and purpose
• § 402.205 — Length of exclusion
• § 402.208 — Factors considered in determining whether to exclude, and the length of exclusion
• § 402.209 — Scope and effect of exclusion
• § 402.210 — Notices
• § 402.212 — Response to notice of proposed determination to exclude
• § 402.214 — Appeal of exclusion
• § 402.300 — Request for reinstatement
• § 402.302 — Basis for reinstatement
• § 402.304 — Approval of request for reinstatement
• § 402.306 — Denial of request for reinstatement
• § 402.308 — Waivers of exclusions

PART 403

• § 403.200 — Basis and scope
• § 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
• § 403.220 — Supplemental Health Insurance Panel
• § 403.222 — State with an approved regulatory program
• § 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
• § 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
• § 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
• § 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
• § 403.745 — Condition of participation: Building safety
• § 403.746 — Condition of participation: Utilization review
• § 403.748 — Condition of participation: Emergency preparedness
• § 403.750 — Estimate of expenditures and adjustments
• § 403.752 — Payment provisions
• § 403.754 — Monitoring expenditure level
• § 403.756 — Sunset provision
• § 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
• § 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 and 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
• § 403.900 — Purpose and scope
• § 403.902 — Definitions
• § 403.904 — Reports of payments or other transfers of value to covered recipients
• § 403.906 — Reports of physician ownership and investment interests
• § 403.908 — Procedures for electronic submission of reports
• § 403.910 — Delayed publication for payments made under product research or development agreements and clinical investigations
• § 403.912 — Penalties for failure to report
• § 403.914 — Preemption of State laws
• § 403.1100 — Purpose and scope
• § 403.1105 — Definitions
• § 403.1110 — Evaluation of models
• § 403.1200 — Scope
• § 403.1201 — Definitions
• § 403.1202 — Pricing information
• § 403.1203 — Specific presentation requirements
• § 403.1204 — Compliance

PART 405

• § 405.201 — Scope of subpart and definitions
• § 405.203 — FDA categorization of investigational devices
• § 405.205 — Coverage of a Category B (Nonexperimental/investigational) device
• § 405.207 — Services related to a noncovered device
• § 405.209 — Payment for a Category B (Nonexperimental/investigational) device
• § 405.211 — Coverage of items and services in FDA-approved IDE studies
• § 405.212 — Medicare Coverage IDE study criteria
• § 405.213 — Re-evaluation of a device categorization
• § 405.215 — Confidential commercial and trade secret information
• § 405.301 — Scope of subpart
• § 405.350 — Individual's liability for payments made to providers and other persons for items and services furnished the individual
• § 405.351 — Incorrect payments for which the individual is not liable
• § 405.352 — Adjustment of title XVIII incorrect payments
• § 405.353 — Certification of amount that will be adjusted against individual title II or railroad retirement benefits
• § 405.354 — Procedures for adjustment or recovery—title II beneficiary
• § 405.355 — Waiver of adjustment or recovery
• § 405.356 — Principles applied in waiver of adjustment or recovery
• § 405.357 — Notice of right to waiver consideration
• § 405.358 — When waiver of adjustment or recovery may be applied
• § 405.359 — Liability of certifying or disbursing officer
• § 405.370 — Definitions
• § 405.371 — Suspension, offset, and recoupment of Medicare payments to providers and suppliers of services
• § 405.372 — Proceeding for suspension of payment
• § 405.373 — Proceeding for offset or recoupment
• § 405.374 — Opportunity for rebuttal
• § 405.375 — Time limits for, and notification of, administrative determination after receipt of rebuttal statement
• § 405.376 — Suspension and termination of collection action and compromise of claims for overpayment
• § 405.377 — Withholding Medicare payments to recover Medicaid overpayments
• § 405.378 — Interest charges on overpayment and underpayments to providers, suppliers, and other entities
• § 405.379 — Limitation on recoupment of provider and supplier overpayments
• § 405.380 — Collection of past-due amounts on scholarship and loan programs
• § 405.400 — Definitions
• § 405.405 — General rules
• § 405.410 — Conditions for properly opting-out of Medicare
• § 405.415 — Requirements of the private contract
• § 405.420 — Requirements of the opt-out affidavit
• § 405.425 — Effects of opting-out of Medicare
• § 405.430 — Failure to properly opt-out
• § 405.435 — Failure to maintain opt-out
• § 405.440 — Emergency and urgent care services
• § 405.445 — Cancellation of opt-out and early termination of opt-out
• § 405.450 — Appeals
• § 405.455 — Application to Medicare Advantage contracts
• § 405.500 — Basis
• § 405.501 — Determination of reasonable charges
• § 405.502 — Criteria for determining reasonable charges
• § 405.503 — Determining customary charges
• § 405.504 — Determining prevailing charges
• § 405.505 — Determination of locality
• § 405.506 — Charges higher than customary or prevailing charges or lowest charge levels
• § 405.507 — Illustrations of the application of the criteria for determining reasonable charges
• § 405.508 — Determination of comparable circumstances; limitation
• § 405.509 — Determining the inflation-indexed charge
• § 405.511 — Reasonable charges for medical services, supplies, and equipment
• § 405.512 — Carriers' procedural terminology and coding systems
• § 405.515 — Reimbursement for clinical laboratory services billed by physicians
• § 405.517 — Payment for drugs and biologicals that are not paid on a cost or prospective payment basis
• § 405.520 — Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional services
• § 405.534 — Limitation on payment for screening mammography services
• § 405.535 — Special rule for nonparticipating physicians and suppliers furnishing screening mammography services before January 1, 2002
• § 405.800 — Appeals of CMS or a CMS contractor
• § 405.803 — Appeals rights
• § 405.806 — Impact of reversal of contractor determinations on claims processing
• § 405.809 — Reinstatement of provider or supplier billing privileges following corrective action
• § 405.812 — Effective date for DMEPOS supplier's billing privileges
• § 405.815 — Submission of claims
• § 405.818 — Deadline for processing provider enrollment initial determinations
• § 405.900 — Basis and scope
• § 405.902 — Definitions
• § 405.903 — Prepayment review
• § 405.904 — Medicare initial determinations, redeterminations and appeals: General description
• § 405.906 — Parties to the initial determinations, redeterminations, reconsiderations, hearings, and reviews
• § 405.908 — Medicaid State agencies
• § 405.910 — Appointed representatives
• § 405.912 — Assignment of appeal rights
• § 405.920 — Initial determinations
• § 405.921 — Notice of initial determination
• § 405.922 — Time frame for processing initial determinations
• § 405.924 — Actions that are initial determinations
• § 405.925 — Decisions of utilization review committees
• § 405.926 — Actions that are not initial determinations
• § 405.927 — Initial determinations subject to the reopenings process
• § 405.928 — Effect of the initial determination
• § 405.929 — Post-payment review
• § 405.930 — Failure to respond to additional documentation request
• § 405.931 — Scope, basis, and definitions
• § 405.932 — Right to appeal a denial of Part A coverage resulting from a change in patient status
• § 405.934 — Reconsideration
• § 405.936 — Hearings before an ALJ and decisions by an ALJ or Attorney Adjudicator
• § 405.938 — Review by the Medicare Appeals Council and judicial review
• § 405.940 — Right to a redetermination
• § 405.942 — Time frame for filing a request for a redetermination
• § 405.944 — Place and method of filing a request for a redetermination
• § 405.946 — Evidence to be submitted with the redetermination request
• § 405.947 — Notice to the beneficiary of applicable plan's request for a redetermination
• § 405.948 — Conduct of a redetermination
• § 405.950 — Time frame for making a redetermination
• § 405.952 — Withdrawal or dismissal of a request for a redetermination
• § 405.954 — Redetermination
• § 405.956 — Notice of a redetermination
• § 405.958 — Effect of a redetermination
• § 405.960 — Right to a reconsideration
• § 405.962 — Timeframe for filing a request for a reconsideration
• § 405.964 — Place and method of filing a request for a reconsideration
• § 405.966 — Evidence to be submitted with the reconsideration request
• § 405.968 — Conduct of a reconsideration
• § 405.970 — Timeframe for making a reconsideration following a contractor redetermination
• § 405.972 — Withdrawal or dismissal of a request for reconsideration or review of a contractor's dismissal of a request for redetermination
• § 405.974 — Reconsideration and review of a contractor's dismissal of a request for redetermination
• § 405.976 — Notice of a reconsideration
• § 405.978 — Effect of a reconsideration
• § 405.980 — Reopening of initial determinations, redeterminations, reconsiderations, decisions, and reviews
• § 405.982 — Notice of a revised determination or decision
• § 405.984 — Effect of a revised determination or decision
• § 405.986 — Good cause for reopening
• § 405.990 — Expedited access to judicial review
• § 405.1000 — Hearing before an ALJ and decision by an ALJ or attorney adjudicator: General rule
• § 405.1002 — Right to an ALJ hearing
• § 405.1004 — Right to a review of QIC notice of dismissal
• § 405.1006 — Amount in controversy required for an ALJ hearing and judicial review
• § 405.1008 — Parties to the proceedings on a request for an ALJ hearing
• § 405.1010 — When CMS or its contractors may participate in the proceedings on a request for an ALJ hearing
• § 405.1012 — When CMS or its contractors may be a party to a hearing
• § 405.1014 — Request for an ALJ hearing or a review of a QIC dismissal
• § 405.1016 — Time frames for deciding an appeal of a QIC reconsideration or escalated request for a QIC reconsideration
• § 405.1018 — Submitting evidence
• § 405.1020 — Time and place for a hearing before an ALJ
• § 405.1022 — Notice of a hearing before an ALJ
• § 405.1024 — Objections to the issues
• § 405.1026 — Disqualification of the ALJ or attorney adjudicator
• § 405.1028 — Review of evidence submitted by parties
• § 405.1030 — ALJ hearing procedures
• § 405.1032 — Issues before an ALJ or attorney adjudicator
• § 405.1034 — Requesting information from the QIC
• § 405.1036 — Description of an ALJ hearing process
• § 405.1037 — Discovery
• § 405.1038 — Deciding a case without a hearing before an ALJ
• § 405.1040 — Prehearing and posthearing conferences
• § 405.1042 — The administrative record
• § 405.1044 — Consolidated proceedings
• § 405.1046 — Notice of an ALJ or attorney adjudicator decision
• § 405.1048 — The effect of an ALJ's or attorney adjudicator's decision
• § 405.1050 — Removal of a hearing request from OMHA to the Council
• § 405.1052 — Dismissal of a request for a hearing before an ALJ or request for review of a QIC dismissal
• § 405.1054 — Effect of dismissal of a request for a hearing or request for review of QIC dismissal
• § 405.1056 — Remands of requests for hearing and requests for review
• § 405.1058 — Effect of a remand
• § 405.1060 — Applicability of national coverage determinations (NCDs)
• § 405.1062 — Applicability of local coverage determinations and other policies not binding on the ALJ or attorney adjudicator and Council
• § 405.1063 — Applicability of laws, regulations, CMS Rulings, and precedential decisions
• § 405.1100 — Medicare Appeals Council review: General
• § 405.1102 — Request for Council review when ALJ or attorney adjudicator issues decision or dismissal
• § 405.1106 — Where a request for review or escalation may be filed
• § 405.1108 — Council actions when request for review or escalation is filed
• § 405.1110 — Council reviews on its own motion
• § 405.1112 — Content of request for review
• § 405.1114 — Dismissal of request for review
• § 405.1116 — Effect of dismissal of request for Council review or request for hearing
• § 405.1118 — Obtaining evidence from the Council
• § 405.1120 — Filing briefs with the Council
• § 405.1122 — What evidence may be submitted to the Council
• § 405.1124 — Oral argument
• § 405.1126 — Case remanded by the Council
• § 405.1128 — Action of the Council
• § 405.1130 — Effect of the Council's decision
• § 405.1132 — Request for escalation to Federal court
• § 405.1134 — Extension of time to file action in Federal district court
• § 405.1136 — Judicial review
• § 405.1138 — Case remanded by a Federal district court
• § 405.1140 — Council review of ALJ decision in a case remanded by a Federal district court
• § 405.1200 — Notifying beneficiaries of provider service terminations
• § 405.1202 — Expedited determination procedures
• § 405.1204 — Expedited reconsiderations
• § 405.1205 — Notifying beneficiaries of hospital discharge appeal rights
• § 405.1206 — Expedited determination procedures for inpatient hospital care
• § 405.1208 — Hospital requests expedited QIO review
• § 405.1210 — Notifying eligible beneficiaries of appeal rights when a beneficiary is reclassified from an inpatient to an outpatient receiving observation services
• § 405.1211 — Expedited determination procedures when a beneficiary is reclassified from an inpatient to an outpatient receiving observation services
• § 405.1212 — Expedited reconsideration procedures regarding Part A coverage when a beneficiary is reclassified from an inpatient to an outpatient receiving observation services
• § 405.1801 — Introduction
• § 405.1803 — Contractor determination and notice of amount of program reimbursement
• § 405.1804 — Matters not subject to administrative and judicial review under prospective payment
• § 405.1805 — Parties to contractor determination
• § 405.1807 — Effect of contractor determination
• § 405.1809 — Contractor hearing procedures
• § 405.1811 — Right to contractor hearing; contents of, and adding issues to, hearing request
• § 405.1813 — Good cause extension of time limit for requesting a contractor hearing
• § 405.1814 — Contractor hearing officer jurisdiction
• § 405.1815 — Parties to proceedings before the contractor hearing officer(s)
• § 405.1817 — Hearing officer or panel of hearing officers authorized to conduct contractor hearing; disqualification of officers
• § 405.1819 — Conduct of contractor hearing
• § 405.1821 — Prehearing discovery and other proceedings prior to the contractor hearing
• § 405.1823 — Evidence at contractor hearing
• § 405.1825 — Witnesses at contractor hearing
• § 405.1827 — Record of proceedings before the contractor hearing officer(s)
• § 405.1829 — Scope of authority of contractor hearing officer(s)
• § 405.1831 — Contractor hearing decision
• § 405.1832 — Contractor hearing officer review of compliance with the substantive reimbursement requirement of an appropriate cost report claim
• § 405.1833 — Effect of contractor hearing decision
• § 405.1834 — CMS reviewing official procedure
• § 405.1835 — Right to Board hearing; contents of, and adding issues to, hearing request
• § 405.1836 — Good cause extension of time limit for requesting a Board hearing
• § 405.1837 — Group appeals
• § 405.1839 — Amount in controversy
• § 405.1840 — Board jurisdiction
• § 405.1842 — Expedited judicial review
• § 405.1843 — Parties to proceedings in a Board appeal
• § 405.1845 — Composition of Board; hearings, decisions, and remands
• § 405.1847 — Disqualification of Board members
• § 405.1849 — Establishment of time and place of hearing by the Board
• § 405.1851 — Conduct of Board hearing
• § 405.1853 — Board proceedings prior to any hearing; discovery
• § 405.1855 — Evidence at Board hearing
• § 405.1857 — Subpoenas
• § 405.1859 — Witnesses
• § 405.1861 — Oral argument and written allegations
• § 405.1863 — Administrative policy at issue
• § 405.1865 — Record of administrative proceedings
• § 405.1867 — Scope of Board's legal authority
• § 405.1868 — Board actions in response to failure to follow Board rules
• § 405.1869 — Scope of Board's authority in a hearing decision
• § 405.1871 — Board hearing decision
• § 405.1873 — Board review of compliance with the reimbursement requirement of an appropriate cost report claim
• § 405.1875 — Administrator review
• § 405.1877 — Judicial review
• § 405.1881 — Appointment of representative
• § 405.1883 — Authority of representative
• § 405.1885 — Reopening a contractor determination or reviewing entity decision
• § 405.1887 — Notice of reopening; effect of reopening
• § 405.1889 — Effect of a revision; issue-specific nature of appeals of revised determinations and decisions
• § 405.2100-405.2101 — 405.2100-405.2101 [Reserved]
• § 405.2102 — Definitions
• § 405.2110 — Designation of ESRD networks
• § 405.2111 — [Reserved]
• § 405.2112 — ESRD network organizations
• § 405.2113 — Medical review board
• § 405.2114 — [Reserved]
• § 405.2131-405.2184 — 405.2131-405.2184 [Reserved]
• § 405.2400 — Basis
• § 405.2401 — Scope and definitions
• § 405.2402 — Rural health clinic basic requirements
• § 405.2403 — Rural health clinic content and terms of the agreement with the Secretary
• § 405.2404 — Termination of rural health clinic agreements
• § 405.2410 — Application of Part B deductible and coinsurance
• § 405.2411 — Scope of benefits
• § 405.2412 — Physicians' services
• § 405.2413 — Services and supplies incident to a physician's services
• § 405.2414 — Nurse practitioner, physician assistant, and certified nurse midwife services
• § 405.2415 — Incident to services and direct supervision
• § 405.2416 — Visiting nurse services
• § 405.2417 — Visiting nurse services: Determination of shortage of agencies
• § 405.2430 — Basic requirements
• § 405.2434 — Content and terms of the agreement
• § 405.2436 — Termination of agreement
• § 405.2440 — Conditions for reinstatement after termination by CMS
• § 405.2442 — Notice to the public
• § 405.2444 — Change of ownership
• § 405.2446 — Scope of services
• § 405.2448 — Preventive primary services
• § 405.2449 — Preventive services
• § 405.2450 — Clinical psychologist, clinical social worker, marriage and family therapist, and mental health counselor services
• § 405.2452 — Services and supplies incident to clinical psychologist, clinical social worker, marriage and family therapist, and mental health counselor services
• § 405.2460 — Applicability of general payment exclusions
• § 405.2462 — Payment for RHC and FQHC services
• § 405.2463 — What constitutes a visit
• § 405.2464 — Payment rate
• § 405.2466 — Annual reconciliation
• § 405.2467 — Requirements of the FQHC PPS
• § 405.2468 — Allowable costs
• § 405.2469 — FQHC supplemental payments
• § 405.2470 — Reports and maintenance of records
• § 405.2472 — Beneficiary appeals

PART 406

• § 406.1 — Statutory basis
• § 406.2 — Scope
• § 406.3 — Definitions
• § 406.5 — Basis of eligibility and entitlement
• § 406.6 — Application or enrollment for hospital insurance
• § 406.7 — Forms to apply for entitlement under Medicare Part A
• § 406.10 — Individual age 65 or over who is entitled to social security or railroad retirement benefits, or who is eligible for social security benefits
• § 406.11 — Individual age 65 or over who is not eligible as a social security or railroad retirement benefits beneficiary, or on the basis of government employment
• § 406.12 — Individual under age 65 who is entitled to social security or railroad retirement disability benefits
• § 406.13 — Individual who has end-stage renal disease
• § 406.15 — Special provisions applicable to Medicare qualified government employment
• § 406.20 — Basic requirements
• § 406.21 — Individual enrollment
• § 406.22 — Effect of month of enrollment on entitlement
• § 406.24 — Special enrollment period related to coverage under group health plans
• § 406.25 — Special enrollment period for volunteers outside the United States
• § 406.26 — Enrollment under State buy-in
• § 406.27 — Special enrollment periods for exceptional conditions
• § 406.28 — End of entitlement
• § 406.32 — Monthly premiums
• § 406.33 — Determination of months to be counted for premium increase: Enrollment
• § 406.34 — Determination of months to be counted for premium increase: Reenrollment
• § 406.38 — Prejudice to enrollment rights because of Federal Government error
• § 406.50 — Nonpayment of benefits on behalf of certain aliens
• § 406.52 — Conviction of certain offenses

PART 407

• § 407.1 — Basis and scope
• § 407.2 — General description of program
• § 407.4 — Basic requirements for entitlement
• § 407.10 — Eligibility to enroll
• § 407.11 — Forms used to apply for enrollment under Medicare Part B
• § 407.12 — General enrollment provisions
• § 407.14 — Initial enrollment period
• § 407.15 — General enrollment period
• § 407.17 — Automatic enrollment
• § 407.18 — Determining month of automatic enrollment
• § 407.20 — Special enrollment period related to coverage under group health plans
• § 407.21 — Special enrollment period for volunteers outside the United States
• § 407.22 — Request for individual enrollment
• § 407.23 — Special enrollment periods for exceptional conditions
• § 407.25 — Beginning of entitlement: Individual enrollment
• § 407.27 — Termination of entitlement: Individual enrollment
• § 407.30 — Limitations on enrollment
• § 407.32 — Prejudice to enrollment rights because of Federal Government misrepresentation, inaction, or error
• § 407.40 — Enrollment under a State buy-in agreement
• § 407.42 — Buy-in groups available to the 50 States, the District of Columbia, and the Northern Mariana Islands
• § 407.43 — Buy-in groups available to Puerto Rico, Guam, the Virgin Islands, and American Samoa
• § 407.47 — Beginning of coverage under a State buy-in agreement
• § 407.48 — Termination of coverage under a State buy-in agreement
• § 407.50 — Continuation of coverage: Individual enrollment following end of coverage under a State buy-in agreement
• § 407.55 — Eligibility to enroll
• § 407.57 — Part B-ID benefit enrollment
• § 407.59 — Attestation
• § 407.62 — Termination of coverage

PART 408

• § 408.1 — Statutory basis
• § 408.2 — Scope and purpose
• § 408.3 — Definitions
• § 408.4 — Payment obligations
• § 408.6 — Methods and priorities for payment
• § 408.8 — Grace period and termination date
• § 408.10 — Claim for monthly benefits pending concurrently with request for SMI enrollment
• § 408.20 — Monthly premiums
• § 408.21 — Reduction in Medicare Part B premium as an additional benefit under Medicare + Choice plans
• § 408.22 — Increased premiums for late enrollment and for reenrollment
• § 408.24 — Individuals who enrolled or reenrolled before April 1, 1981 or after September 30, 1981
• § 408.25 — Individuals who enrolled or reenrolled between April 1 and September 30, 1981
• § 408.26 — Examples
• § 408.27 — Rounding the monthly premium
• § 408.28 — Increased premiums due to the income-related monthly adjustment amount (IRMAA)
• § 408.40 — Deduction from monthly benefits: Basic rules
• § 408.42 — Deduction from railroad retirement benefits
• § 408.43 — Deduction from social security benefits
• § 408.44 — Deduction from civil service annuities
• § 408.45 — Deduction from age 72 special payments
• § 408.46 — Effect of suspension of social security benefits
• § 408.47 — [Reserved]
• § 408.50 — When premiums are considered paid
• § 408.52 — Change from direct remittance to deduction
• § 408.53 — Change from partial direct remittance to full deduction
• § 408.60 — Direct remittance: Basic rules
• § 408.62 — Initial and subsequent billings
• § 408.63 — Billing procedures when monthly benefits are less than monthly premiums
• § 408.65 — Payment options
• § 408.68 — When premiums are considered paid
• § 408.70 — Change from quarterly to monthly payments
• § 408.71 — Change from deduction or State payment to direct remittance
• § 408.80 — Basic rules
• § 408.82 — Conditions for group billing
• § 408.84 — Billing and payment procedures
• § 408.86 — Responsibilities under group billing arrangement
• § 408.88 — Refund of group payments
• § 408.90 — Termination of group billing arrangement
• § 408.92 — Change from group payment to deduction or individual payment
• § 408.100 — Termination of coverage for nonpayment of premiums
• § 408.102 — Reconsideration of termination
• § 408.104 — Reinstatement procedures
• § 408.110 — Collection of unpaid premiums
• § 408.112 — Refund of excess premiums after the enrollee dies
• § 408.200 — Statutory basis
• § 408.201 — Definitions
• § 408.202 — Conditions for participation
• § 408.205 — Application procedures
• § 408.207 — Billing and payment procedures
• § 408.210 — Termination of SMI premium surcharge agreement

PART 409

• § 409.1 — Statutory basis
• § 409.2 — Scope
• § 409.3 — Definitions
• § 409.5 — General description of benefits
• § 409.10 — Included services
• § 409.11 — Bed and board
• § 409.12 — Nursing and related services, medical social services; use of hospital or CAH facilities
• § 409.13 — Drugs and biologicals
• § 409.14 — Supplies, appliances, and equipment
• § 409.15 — Services furnished by an intern or a resident-in-training
• § 409.16 — Other diagnostic or therapeutic services
• § 409.17 — Physical therapy, occupational therapy, and speech-language pathology services
• § 409.18 — Services related to kidney transplantations
• § 409.20 — Coverage of services
• § 409.21 — Nursing care
• § 409.22 — Bed and board
• § 409.23 — Physical therapy, occupational therapy, and speech-language pathology services
• § 409.24 — Medical social services
• § 409.25 — Drugs, biologicals, supplies, appliances, and equipment
• § 409.26 — Transfer agreement hospital services
• § 409.27 — Other services generally provided by (or under arrangements made by) SNFs
• § 409.30 — Basic requirements
• § 409.31 — Level of care requirement
• § 409.32 — Criteria for skilled services and the need for skilled services
• § 409.33 — Examples of skilled nursing and rehabilitation services
• § 409.34 — Criteria for “daily basis”
• § 409.35 — Criteria for “practical matter”
• § 409.36 — Effect of discharge from posthospital SNF care
• § 409.40 — Basis, purpose, and scope
• § 409.41 — Requirement for payment
• § 409.42 — Beneficiary qualifications for coverage of services
• § 409.43 — Plan of care requirements
• § 409.44 — Skilled services requirements
• § 409.45 — Dependent services requirements
• § 409.46 — Allowable administrative costs
• § 409.47 — Place of service requirements
• § 409.48 — Visits
• § 409.49 — Excluded services
• § 409.50 — Coinsurance for durable medical equipment (DME) and applicable disposable devices furnished as a home health service
• § 409.60 — Benefit periods
• § 409.61 — General limitations on amount of benefits
• § 409.62 — Lifetime maximum on inpatient psychiatric care
• § 409.63 — Reduction of inpatient psychiatric benefit days available in the initial benefit period
• § 409.64 — Services that are counted toward allowable amounts
• § 409.65 — Lifetime reserve days
• § 409.66 — Revocation of election not to use lifetime reserve days
• § 409.68 — Guarantee of payment for inpatient hospital or inpatient CAH services furnished before notification of exhaustion of benefits
• § 409.80 — Inpatient deductible and coinsurance: General provisions
• § 409.82 — Inpatient hospital deductible
• § 409.83 — Inpatient hospital coinsurance
• § 409.85 — Skilled nursing facility (SNF) care coinsurance
• § 409.87 — Blood deductible
• § 409.89 — Exemption of kidney donors from deductible and coinsurance requirements
• § 409.100 — To whom payment is made
• § 409.102 — Amounts of payment

PART 410

• § 410.1 — Basis and scope
• § 410.2 — Definitions
• § 410.3 — Scope of benefits
• § 410.5 — Other applicable rules
• § 410.10 — Medical and other health services: Included services
• § 410.12 — Medical and other health services: Basic conditions and limitations
• § 410.14 — Special requirements for services furnished outside the United States
• § 410.15 — Annual wellness visits providing Personalized Prevention Plan Services: Conditions for and limitations on coverage
• § 410.16 — Initial preventive physical examination: Conditions for and limitations on coverage
• § 410.17 — Cardiovascular disease screening tests
• § 410.18 — Diabetes screening tests
• § 410.19 — Ultrasound screening for abdominal aortic aneurysms: Condition for and limitation on coverage
• § 410.20 — Physicians' services
• § 410.21 — Limitations on services of a chiropractor
• § 410.22 — Limitations on services of an optometrist
• § 410.23 — Screening for glaucoma: Conditions for and limitations on coverage
• § 410.24 — Limitations on services of a doctor of dental surgery or dental medicine
• § 410.25 — Limitations on services of a podiatrist
• § 410.26 — Services and supplies incident to a physician's professional services: Conditions
• § 410.27 — Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or nonphysician practitioner's service: Conditions
• § 410.28 — Hospital or CAH diagnostic services furnished to outpatients: Conditions
• § 410.29 — Limitations on drugs and biologicals
• § 410.30 — Prescription drugs used in immunosuppressive therapy
• § 410.31 — Bone mass measurement: Conditions for coverage and frequency standards
• § 410.32 — Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions
• § 410.33 — Independent diagnostic testing facility
• § 410.34 — Mammography services: Conditions for and limitations on coverage
• § 410.35 — X-ray therapy and other radiation therapy services: Scope
• § 410.36 — Medical supplies, appliances, and devices: Scope
• § 410.37 — Colorectal cancer screening tests: Conditions for and limitations on coverage
• § 410.38 — Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS): Scope and conditions
• § 410.39 — Prostate cancer screening tests: Conditions for and limitations on coverage
• § 410.40 — Coverage of ambulance services
• § 410.41 — Requirements for ambulance providers and suppliers
• § 410.42 — Limitations on coverage of certain services furnished to hospital outpatients
• § 410.43 — Partial hospitalization services: Conditions and exclusions
• § 410.44 — Intensive outpatient services: Conditions and exclusions
• § 410.45 — Rural health clinic services: Scope and conditions
• § 410.46 — Physician and other practitioner services furnished in or at the direction of an IHS or Indian tribal hospital or clinic: Scope and conditions
• § 410.47 — Pulmonary rehabilitation program: Conditions for coverage
• § 410.48 — Kidney disease education services
• § 410.49 — Cardiac rehabilitation program and intensive cardiac rehabilitation program: Conditions of coverage
• § 410.50 — Institutional dialysis services and supplies: Scope and conditions
• § 410.52 — Home dialysis services, supplies, and equipment: Scope and conditions
• § 410.53 — Marriage and family therapist services
• § 410.54 — Mental health counselor services
• § 410.55 — Services related to kidney donations: Conditions
• § 410.56 — Screening pelvic examinations
• § 410.57 — Preventive vaccines
• § 410.58 — Additional services to HMO and CMP enrollees
• § 410.59 — Outpatient occupational therapy services: Conditions
• § 410.60 — Outpatient physical therapy services: Conditions
• § 410.61 — Plan of treatment requirements for outpatient rehabilitation services
• § 410.62 — Outpatient speech-language pathology services: Conditions and exclusions
• § 410.63 — Hepatitis B vaccine and blood clotting factors: Conditions
• § 410.64 — Additional preventive services
• § 410.66 — Emergency outpatient services furnished by a nonparticipating hospital and services furnished in a foreign country
• § 410.67 — Medicare coverage and payment of Opioid use disorder treatment services furnished by Opioid treatment programs
• § 410.68 — Antigens: Scope and conditions
• § 410.69 — Services of a certified registered nurse anesthetist or an anesthesiologist's assistant: Basic rule and definitions
• § 410.71 — Clinical psychologist services and services and supplies incident to clinical psychologist services
• § 410.72 — Registered dietitians' and nutrition professionals' services
• § 410.73 — Clinical social worker services
• § 410.74 — Physician assistants' services
• § 410.75 — Nurse practitioners' services
• § 410.76 — Clinical nurse specialists' services
• § 410.77 — Certified nurse-midwives' services: Qualifications and conditions
• § 410.78 — Telehealth services
• § 410.79 — Medicare Diabetes Prevention Program expanded model: Conditions of coverage
• § 410.80 — Applicable rules
• § 410.100 — Included services
• § 410.102 — Excluded services
• § 410.105 — Requirements for coverage of CORF services
• § 410.110 — Requirements for coverage of partial hospitalization services by CMHCs
• § 410.111 — Requirements for coverage of intensive outpatient services in CMHCs
• § 410.130 — Definitions
• § 410.132 — Medical nutrition therapy
• § 410.134 — Provider qualifications
• § 410.140 — Definitions
• § 410.141 — Outpatient diabetes self-management training
• § 410.142 — CMS process for approving national accreditation organizations
• § 410.143 — Requirements for approved accreditation organizations
• § 410.144 — Quality standards for deemed entities
• § 410.145 — Requirements for entities
• § 410.146 — Diabetes outcome measurements
• § 410.150 — To whom payment is made
• § 410.152 — Amounts of payment
• § 410.155 — Outpatient mental health treatment limitation
• § 410.160 — Part B annual deductible
• § 410.161 — Part B blood deductible
• § 410.163 — Payment for services furnished to kidney donors
• § 410.165 — Payment for rural health clinic services and ambulatory surgical center services: Conditions
• § 410.170 — Payment for home health services, for medical and other health services furnished by a provider or an approved ESRD facility, and for comprehensive outpatient rehabilitation facility (CORF) services: Conditions
• § 410.172 — Payment for partial hospitalization services in CMHCs: Conditions
• § 410.173 — Payment for intensive outpatient services in CMHCs: Conditions
• § 410.175 — Alien absent from the United States

PART 411

• § 411.1 — Basis and scope
• § 411.2 — Conclusive effect of QIO determinations on payment of claims
• § 411.4 — Items and services for which neither the beneficiary nor any other person is legally obligated to pay
• § 411.6 — Services furnished by a Federal provider of services or other Federal agency
• § 411.7 — Services that must be furnished at public expense under a Federal law or Federal Government contract
• § 411.8 — Services paid for by a Government entity
• § 411.9 — Services furnished outside the United States
• § 411.10 — Services required as a result of war
• § 411.12 — Charges imposed by an immediate relative or member of the beneficiary's household
• § 411.15 — Particular services excluded from coverage
• § 411.20 — Basis and scope
• § 411.21 — Definitions
• § 411.22 — Reimbursement obligations of primary payers and entities that received payment from primary payers
• § 411.23 — Beneficiary's cooperation
• § 411.24 — Recovery of conditional payments
• § 411.25 — Primary payer's notice of primary payment responsibility
• § 411.26 — Subrogation and right to intervene
• § 411.28 — Waiver of recovery and compromise of claims
• § 411.30 — Effect of primary payment on benefit utilization and deductibles
• § 411.31 — Authority to bill primary payers for full charges
• § 411.32 — Basis for Medicare secondary payments
• § 411.33 — Amount of Medicare secondary payment
• § 411.35 — Limitations on charges to a beneficiary or other party when a workers' compensation plan, a no-fault insurer, or an employer group health plan is primary payer
• § 411.37 — Amount of Medicare recovery when a primary payment is made as a result of a judgment or settlement
• § 411.39 — Automobile and liability insurance (including self-insurance), no-fault insurance, and workers' compensation: Final conditional payment amounts via Web portal
• § 411.40 — General provisions
• § 411.43 — Beneficiary's responsibility with respect to workers' compensation
• § 411.45 — Basis for conditional Medicare payment in workers' compensation cases
• § 411.46 — Lump-sum payments
• § 411.47 — Apportionment of a lump-sum compromise settlement of a workers' compensation claim
• § 411.50 — General provisions
• § 411.51 — Beneficiary's responsibility with respect to no-fault insurance
• § 411.52 — Basis for conditional Medicare payment in liability cases
• § 411.53 — Basis for conditional Medicare payment in no-fault cases
• § 411.54 — Limitation on charges when a beneficiary has received a liability insurance payment or has a claim pending against a liability insurer
• § 411.100 — Basis and scope
• § 411.101 — Definitions
• § 411.102 — Basic prohibitions and requirements
• § 411.103 — Prohibition against financial and other incentives
• § 411.104 — Current employment status
• § 411.106 — Aggregation rules
• § 411.108 — Taking into account entitlement to Medicare
• § 411.110 — Basis for determination of nonconformance
• § 411.112 — Documentation of conformance
• § 411.114 — Determination of nonconformance
• § 411.115 — Notice of determination of nonconformance
• § 411.120 — Appeals
• § 411.121 — Hearing procedures
• § 411.122 — Hearing officer's decision
• § 411.124 — Administrator's review of hearing decision
• § 411.126 — Reopening of determinations and decisions
• § 411.130 — Referral to Internal Revenue Service (IRS)
• § 411.160 — Scope
• § 411.161 — Prohibition against taking into account Medicare eligibility or entitlement or differentiating benefits
• § 411.162 — Medicare benefits secondary to group health plan benefits
• § 411.163 — Coordination of benefits: Dual entitlement situations
• § 411.165 — Basis for conditional Medicare payments
• § 411.170 — General provisions
• § 411.172 — Medicare benefits secondary to group health plan benefits
• § 411.175 — Basis for Medicare primary payments
• § 411.200 — Basis
• § 411.201 — Definitions
• § 411.204 — Medicare benefits secondary to LGHP benefits
• § 411.206 — Basis for Medicare primary payments and limits on secondary payments
• § 411.350 — Scope of subpart
• § 411.351 — Definitions
• § 411.352 — Group practice
• § 411.353 — Prohibition on certain referrals by physicians and limitations on billing
• § 411.354 — Financial relationship, compensation, and ownership or investment interest
• § 411.355 — General exceptions to the referral prohibition related to both ownership/investment and compensation
• § 411.356 — Exceptions to the referral prohibition related to ownership or investment interests
• § 411.357 — Exceptions to the referral prohibition related to compensation arrangements
• § 411.361 — Reporting requirements
• § 411.362 — Additional requirements concerning physician ownership and investment in hospitals
• § 411.363 — Process for requesting an exception from the prohibition on facility expansion
• § 411.370 — Advisory opinions relating to physician referrals
• § 411.372 — Procedure for submitting a request
• § 411.373 — Certification
• § 411.375 — Fees for the cost of advisory opinions
• § 411.377 — Expert opinions from outside sources
• § 411.378 — Withdrawing a request
• § 411.379 — When CMS accepts a request
• § 411.380 — When CMS issues a formal advisory opinion
• § 411.382 — CMS' right to rescind advisory opinions
• § 411.384 — Disclosing advisory opinions and supporting information
• § 411.386 — CMS's advisory opinions as exclusive
• § 411.387 — Effect of an advisory opinion
• § 411.388 — When advisory opinions are not admissible evidence
• § 411.389 — Range of the advisory opinion
• § 411.400 — Payment for custodial care and services not reasonable and necessary
• § 411.402 — Indemnification of beneficiary
• § 411.404 — Criteria for determining that a beneficiary knew that services were excluded from coverage as custodial care or as not reasonable and necessary
• § 411.406 — Criteria for determining that a provider, practitioner, or supplier knew that services were excluded from coverage as custodial care or as not reasonable and necessary
• § 411.408 — Refunds of amounts collected for physician services not reasonable and necessary, payment not accepted on an assignment-related basis

PART 412

• § 412.1 — Scope of part
• § 412.2 — Basis of payment
• § 412.3 — Admissions
• § 412.4 — Discharges and transfers
• § 412.6 — Cost reporting periods subject to the prospective payment systems
• § 412.8 — Publication of schedules for determining prospective payment rates
• § 412.10 — Changes in the DRG classification system
• § 412.20 — Hospital services subject to the prospective payment systems
• § 412.22 — Excluded hospitals and hospital units: General rules
• § 412.23 — Excluded hospitals: Classifications
• § 412.24 — Requirements under the PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program
• § 412.25 — Excluded hospital units: Common requirements
• § 412.27 — Excluded psychiatric units: Additional requirements
• § 412.29 — Classification criteria for payment under the inpatient rehabilitation facility prospective payment system
• § 412.30 — [Reserved]
• § 412.40 — General requirements
• § 412.42 — Limitations on charges to beneficiaries
• § 412.44 — Medical review requirements: Admissions and quality review
• § 412.46 — Medical review requirements
• § 412.48 — Denial of payment as a result of admissions and quality review
• § 412.50 — Furnishing of inpatient hospital services directly or under arrangements
• § 412.52 — Reporting and recordkeeping requirements
• § 412.60 — DRG classification and weighting factors
• § 412.62 — Federal rates for inpatient operating costs for fiscal year 1984
• § 412.63 — Federal rates for inpatient operating costs for Federal fiscal years 1984 through 2004
• § 412.64 — Federal rates for inpatient operating costs for Federal fiscal year 2005 and subsequent fiscal years
• § 412.70 — General description
• § 412.71 — Determination of base-year inpatient operating costs
• § 412.72 — Modification of base-year costs
• § 412.73 — Determination of the hospital-specific rate based on a Federal fiscal year 1982 base period
• § 412.75 — Determination of the hospital-specific rate for inpatient operating costs based on a Federal fiscal year 1987 base period
• § 412.76 — Recovery of excess transition period payment amounts resulting from unlawful claims
• § 412.77 — Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 1996 base period
• § 412.78 — Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 2006 base period
• § 412.79 — Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent, small rural hospitals based on a Federal fiscal year 2002 base period
• § 412.80 — Outlier cases: General provisions
• § 412.82 — Payment for extended length-of-stay cases (day outliers)
• § 412.83 — Payment for extraordinarily high-cost day outliers
• § 412.84 — Payment for extraordinarily high-cost cases (cost outliers)
• § 412.85 — Payment adjustment for certain immunotherapy cases
• § 412.86 — 412.86 [Reserved]
• § 412.87 — Additional payment for new medical services and technologies: General provisions
• § 412.88 — Additional payment for new medical service or technology
• § 412.89 — Payment adjustment for certain replaced devices
• § 412.90 — General rules
• § 412.92 — Special treatment: Sole community hospitals
• § 412.96 — Special treatment: Referral centers
• § 412.98 — [Reserved]
• § 412.100 — Special treatment: Kidney transplant programs
• § 412.101 — Special treatment: Inpatient hospital payment adjustment for low-volume hospitals
• § 412.102 — Special treatment: Hospitals located in areas that are changing from urban to rural as a result of a geographic redesignation
• § 412.103 — Special treatment: Hospitals located in urban areas and that apply for reclassification as rural
• § 412.104 — Special treatment: Hospitals with high percentage of ESRD discharges
• § 412.105 — Special treatment: Hospitals that incur indirect costs for graduate medical education programs
• § 412.106 — Special treatment: Hospitals that serve a disproportionate share of low-income patients
• § 412.107 — Special treatment: Hospitals that receive an additional update for FYs 1998 and 1999
• § 412.108 — Special treatment: Medicare-dependent, small rural hospitals
• § 412.109 — Special treatment: Essential access community hospitals (EACHs)
• § 412.110 — Total Medicare payment
• § 412.112 — Payments determined on a per case basis
• § 412.113 — Other payments
• § 412.115 — Additional payments
• § 412.116 — Method of payment
• § 412.120 — Reductions to total payments
• § 412.125 — Effect of change of ownership on payments under the prospective payment systems
• § 412.130 — Retroactive adjustments for incorrectly excluded hospitals and units
• § 412.140 — Participation, data submission, and validation requirements under the Hospital Inpatient Quality Reporting (IQR) Program
• § 412.150 — Basis and scope of subpart
• § 412.152 — Definitions for the Hospital Readmissions Reduction Program
• § 412.154 — Payment adjustments under the Hospital Readmissions Reduction Program
• § 412.155-412.159 — 412.155-412.159 [Reserved]
• § 412.160 — Definitions for the Hospital Value-Based Purchasing (VBP) Program
• § 412.161 — Applicability of the Hospital Value-Based Purchasing (VBP) Program
• § 412.162 — Process for reducing the base operating DRG payment amount and applying the value-based incentive payment amount adjustment under the Hospital Value-Based Purchasing (VBP) Program
• § 412.163 — Process for making hospital-specific performance information under the Hospital Value-Based Purchasing (VBP) Program available to the public
• § 412.164 — Measure selection under the Hospital Value-Based Purchasing (VBP) Program
• § 412.165 — Performance scoring under the Hospital Value-Based Purchasing (VBP) Program
• § 412.167 — Appeal under the Hospital Value-Based Purchasing (VBP) Program
• § 412.168 — Special rules for FY 2022 and FY 2023
• § 412.169 — [Reserved]
• § 412.170 — Definitions for the Hospital-Acquired Condition Reduction Program
• § 412.172 — Payment adjustments under the Hospital-Acquired Condition Reduction Program
• § 412.190 — Overall Hospital Quality Star Rating
• § 412.200 — General provisions
• § 412.204 — Payment to hospitals located in Puerto Rico
• § 412.208 — Puerto Rico rates for Federal fiscal year 1988
• § 412.210 — Puerto Rico rates for Federal fiscal years 1989 through 2003
• § 412.211 — Puerto Rico rates for Federal fiscal year 2004 and subsequent fiscal years
• § 412.212 — National rate
• § 412.220 — Special treatment of certain hospitals located in Puerto Rico
• § 412.230 — Criteria for an individual hospital seeking redesignation to another rural area or an urban area
• § 412.232 — Criteria for all hospitals in a rural county seeking urban redesignation
• § 412.234 — Criteria for all hospitals in an urban county seeking redesignation to another urban area
• § 412.235 — Criteria for all hospitals in a State seeking a statewide wage index redesignation
• § 412.246 — MGCRB members
• § 412.248 — Number of members needed for a decision or a hearing
• § 412.250 — Sources of MGCRB's authority
• § 412.252 — Applications
• § 412.254 — Proceedings before MGCRB
• § 412.256 — Application requirements
• § 412.258 — Parties to MGCRB proceeding
• § 412.260 — Time and place of the oral hearing
• § 412.262 — Disqualification of an MGCRB member
• § 412.264 — Evidence and comments in MGCRB proceeding
• § 412.266 — Availability of wage data
• § 412.268 — Subpoenas
• § 412.270 — Witnesses
• § 412.272 — Record of proceedings before the MGCRB
• § 412.273 — Withdrawing an application, terminating an approved 3-year reclassification, or reinstating a previous termination
• § 412.274 — Scope and effect of an MGCRB decision
• § 412.276 — Timing of MGCRB decision and its appeal
• § 412.278 — Administrator's review
• § 412.280 — Representation
• § 412.300 — Scope of subpart and definition
• § 412.302 — Introduction to capital costs
• § 412.304 — Implementation of the capital prospective payment system
• § 412.308 — Determining and updating the Federal rate
• § 412.312 — Payment based on the Federal rate
• § 412.316 — Geographic adjustment factors
• § 412.320 — Disproportionate share adjustment factor
• § 412.322 — Indirect medical education adjustment factor
• § 412.324 — General description
• § 412.328 — Determining and updating the hospital-specific rate
• § 412.331 — Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution
• § 412.332 — Payment based on the hospital-specific rate
• § 412.336 — Transition period payment methodologies
• § 412.340 — Fully prospective payment methodology
• § 412.344 — Hold-harmless payment methodology
• § 412.348 — Exception payments
• § 412.352 — Budget neutrality adjustment
• § 412.370 — General provisions for hospitals located in Puerto Rico
• § 412.374 — Payments to hospitals located in Puerto Rico
• § 412.400 — Basis and scope of subpart
• § 412.402 — Definitions
• § 412.404 — Conditions for payment under the prospective payment system for inpatient hospital services of psychiatric facilities
• § 412.405 — Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system
• § 412.422 — Basis of payment
• § 412.424 — Methodology for calculating the Federal per diem payment amount
• § 412.426 — Transition period
• § 412.428 — Publication of changes to the inpatient psychiatric facility prospective payment system
• § 412.432 — Method of payment under the inpatient psychiatric facility prospective payment system
• § 412.433 — Procedural requirements under the IPFQR Program
• § 412.434 — Reconsideration and appeals procedures of Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program decisions
• § 412.500 — Basis and scope of subpart
• § 412.503 — Definitions
• § 412.505 — Conditions for payment under the prospective payment system for long-term care hospitals
• § 412.507 — Limitation on charges to beneficiaries
• § 412.508 — Medical review requirements
• § 412.509 — Furnishing of inpatient hospital services directly or under arrangement
• § 412.511 — Reporting and recordkeeping requirements
• § 412.513 — Patient classification system
• § 412.515 — LTC-DRG weighting factors
• § 412.517 — Revision of LTC-DRG group classifications and weighting factors
• § 412.521 — Basis of payment
• § 412.522 — Application of site neutral payment rate
• § 412.523 — Methodology for calculating the Federal prospective payment rates
• § 412.525 — Adjustments to the Federal prospective payment
• § 412.526 — Payment provisions for a “subclause (II)” long-term care hospital
• § 412.529 — Special payment provision for short-stay outliers
• § 412.531 — Special payment provisions when an interruption of a stay occurs in a long-term care hospital
• § 412.533 — Transition payments
• § 412.534 — Special payment provisions for long-term care hospitals-within-hospitals and satellites of long-term care hospitals, effective for discharges occurring in cost reporting periods beginning on or before September 30, 2016
• § 412.535 — Publication of the Federal prospective payment rates
• § 412.536 — Special payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharge Medicare patients admitted from a hospital not located in the same building or on the same campus as the long-term care hospital or satellite of the long-term care hospital, effective for discharges occurring on or before September 30, 2016 or in cost reporting periods beginning on or before June 30, 2016
• § 412.538 — [Reserved]
• § 412.540 — Method of payment for preadmission services under the long-term care hospital prospective payment system
• § 412.541 — Method of payment under the long-term care hospital prospective payment system
• § 412.560 — Requirements under the Long-Term Care Hospital Quality Reporting Program (LTCH QRP)
• § 412.600 — Basis and scope of subpart
• § 412.602 — Definitions
• § 412.604 — Conditions for payment under the prospective payment system for inpatient rehabilitation facilities
• § 412.606 — Patient assessments
• § 412.608 — Patients' rights regarding the collection of patient assessment data
• § 412.610 — Assessment schedule
• § 412.612 — Coordination of the collection of patient assessment data
• § 412.614 — Transmission of patient assessment data
• § 412.616 — Release of information collected using the patient assessment instrument
• § 412.618 — Assessment process for interrupted stays
• § 412.620 — Patient classification system
• § 412.622 — Basis of payment
• § 412.624 — Methodology for calculating the Federal prospective payment rates
• § 412.626 — Transition period
• § 412.628 — Publication of the Federal prospective payment rates
• § 412.630 — Limitation on review
• § 412.632 — Method of payment under the inpatient rehabilitation facility prospective payment system
• § 412.634 — Requirements under the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP)

PART 413

• § 413.1 — Introduction
• § 413.5 — Cost reimbursement: General
• § 413.9 — Cost related to patient care
• § 413.13 — Amount of payment if customary charges for services furnished are less than reasonable costs
• § 413.17 — Cost to related organizations
• § 413.20 — Financial data and reports
• § 413.24 — Adequate cost data and cost finding
• § 413.30 — Limitations on payable costs
• § 413.35 — Limitations on coverage of costs: Charges to beneficiaries if cost limits are applied to services
• § 413.40 — Ceiling on the rate of increase in hospital inpatient costs
• § 413.50 — Apportionment of allowable costs
• § 413.53 — Determination of cost of services to beneficiaries
• § 413.56 — [Reserved]
• § 413.60 — Payments to providers: General
• § 413.64 — Payments to providers: Specific rules
• § 413.65 — Requirements for a determination that a facility or an organization has provider-based status
• § 413.70 — Payment for services of a CAH
• § 413.74 — Payment to a foreign hospital
• § 413.75 — Direct GME payments: General requirements
• § 413.76 — Direct GME payments: Calculation of payments for GME costs
• § 413.77 — Direct GME payments: Determination of per resident amounts
• § 413.78 — Direct GME payments: Determination of the total number of FTE residents
• § 413.79 — Direct GME payments: Determination of the weighted number of FTE residents
• § 413.80 — Direct GME payments: Determination of weighting factors for foreign medical graduates
• § 413.81 — Direct GME payments: Application of community support and redistribution of costs in determining FTE resident counts
• § 413.82 — Direct GME payments: Special rules for States that formerly had a waiver from Medicare reimbursement principles
• § 413.83 — Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific rate
• § 413.85 — Cost of approved nursing and allied health education activities
• § 413.87 — Payments for Medicare + Choice nursing and allied health education programs
• § 413.88 — Incentive payments under plans for voluntary reduction in number of medical residents
• § 413.89 — Bad debts, charity, and courtesy allowances
• § 413.90 — Research costs
• § 413.92 — Costs of surety bonds
• § 413.94 — Value of services of nonpaid workers
• § 413.98 — Purchase discounts and allowances, and refunds of expenses
• § 413.99 — Qualified and Non-Qualified Deferred Compensation Plans
• § 413.100 — Special treatment of certain accrued costs
• § 413.102 — Compensation of owners
• § 413.106 — Reasonable cost of physical and other therapy services furnished under arrangements
• § 413.114 — Payment for posthospital SNF care furnished by a swing-bed hospital
• § 413.118 — Payment for facility services related to covered ASC surgical procedures performed in hospitals on an outpatient basis
• § 413.122 — Payment for hospital outpatient radiology services and other diagnostic procedures
• § 413.123 — Payment for screening mammography performed by hospitals on an outpatient basis
• § 413.124 — Reduction to hospital outpatient operating costs
• § 413.125 — Payment for home health agency services
• § 413.130 — Introduction to capital-related costs
• § 413.134 — Depreciation: Allowance for depreciation based on asset costs
• § 413.139 — Depreciation: Optional allowance for depreciation based on a percentage of operating costs
• § 413.144 — Depreciation: Allowance for depreciation on fully depreciated or partially depreciated assets
• § 413.149 — Depreciation: Allowance for depreciation on assets financed with Federal or public funds
• § 413.153 — Interest expense
• § 413.157 — Return on equity capital of proprietary providers
• § 413.170 — Scope
• § 413.171 — Definitions
• § 413.172 — Principles of prospective payment
• § 413.174 — Prospective rates for hospital-based and independent ESRD facilities
• § 413.176 — Amount of payments
• § 413.177 — Quality incentive program payment
• § 413.178 — ESRD quality incentive program
• § 413.180 — Procedures for requesting exceptions to payment rates
• § 413.182 — Criteria for approval of exception requests
• § 413.184 — Payment exception: Pediatric patient mix
• § 413.186 — Payment exception: Self-dialysis training costs in pediatric facilities
• § 413.194 — Appeals
• § 413.195 — Limitation on Review
• § 413.196 — Notification of changes in rate-setting methodologies and payment rates
• § 413.198 — Recordkeeping and cost reporting requirements for outpatient maintenance dialysis
• § 413.200 — [Reserved]
• § 413.202 — Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries
• § 413.203 — Transplant center costs for organs sent to foreign countries or transplanted in patients other than Medicare beneficiaries
• § 413.210 — Conditions for payment under the end-stage renal disease (ESRD) prospective payment system
• § 413.215 — Basis of payment
• § 413.217 — Items and services included in the ESRD prospective payment system
• § 413.220 — Methodology for calculating the per-treatment base rate under the ESRD prospective payment system effective January 1, 2011
• § 413.230 — Determining the per treatment payment amount
• § 413.231 — Adjustment for wages
• § 413.232 — Low-volume adjustment
• § 413.233 — Additional facility-level adjustments
• § 413.234 — Drug designation process
• § 413.235 — Patient-level adjustments
• § 413.236 — Transitional add-on payment adjustment for new and innovative equipment and supplies
• § 413.237 — Outliers
• § 413.239 — Transition period
• § 413.241 — Pharmacy arrangements
• § 413.300 — Basis and scope
• § 413.302 — Definitions
• § 413.304 — Eligibility for prospectively determined payment rates
• § 413.308 — Rules governing election of prospectively determined payment rates
• § 413.310 — Basis of payment
• § 413.312 — Methodology for calculating rates
• § 413.314 — Determining payment amounts: Routine per diem rate
• § 413.316 — Determining payment amounts: Ancillary services
• § 413.320 — Publication of prospectively determined payment rates or amounts
• § 413.321 — Simplified cost report for SNFs
• § 413.330 — Basis and scope
• § 413.333 — Definitions
• § 413.335 — Basis of payment
• § 413.337 — Methodology for calculating the prospective payment rates
• § 413.338 — Skilled nursing facility value-based purchasing program
• § 413.340 — Transition period
• § 413.343 — Resident assessment data
• § 413.345 — Publication of Federal prospective payment rates
• § 413.348 — Limitation on review
• § 413.350 — Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A services
• § 413.355 — Additional payment: QIO reimbursement for cost of sending records electronically or by photocopy and mailing
• § 413.360 — Requirements under the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)
• § 413.370 — Scope
• § 413.371 — Definition
• § 413.372 — AKI dialysis payment rate
• § 413.373 — Other adjustments to the AKI dialysis payment rate
• § 413.374 — Renal dialysis services included in the AKI dialysis payment rate
• § 413.375 — Notification of changes in rate-setting methodologies and payment rates
• § 413.400 — Definitions
• § 413.402 — Organ acquisition costs
• § 413.404 — Standard acquisition charge
• § 413.406 — Acquisition of pancreata for islet cell transplant
• § 413.408 — [Reserved]
• § 413.410 — [Reserved]
• § 413.412 — Intent to transplant, intent for research, counting en bloc, and unusable organs
• § 413.414 — Medicare secondary payer and organ acquisition costs
• § 413.416 — Organ acquisition charges for kidney-paired exchanges
• § 413.418 — Amounts billed to organ procurement organizations for hospital services provided to deceased donors and included as organ acquisition costs
• § 413.420 — Payment to independent organ procurement organizations and histocompatibility laboratories for kidney acquisition costs

PART 414

• § 414.1 — Basis and scope
• § 414.2 — Definitions
• § 414.4 — Fee schedule areas
• § 414.5 — Hospital services paid under Medicare Part B when a Part A hospital inpatient claim is denied because the inpatient admission was not reasonable and necessary, but hospital outpatient services would have been reasonable and necessary in treating the beneficiary
• § 414.20 — Formula for computing fee schedule amounts
• § 414.21 — Medicare payment basis
• § 414.22 — Relative value units (RVUs)
• § 414.24 — Publication of RVUs and direct PE inputs
• § 414.26 — Determining the GAF
• § 414.28 — Conversion factors
• § 414.30 — Conversion factor update
• § 414.34 — Payment for services and supplies incident to a physician's service
• § 414.36 — Payment for drugs incident to a physician's service
• § 414.39 — Special rules for payment of care plan oversight
• § 414.40 — Coding and ancillary policies
• § 414.42 — Adjustment for first 4 years of practice
• § 414.44 — Transition rules
• § 414.46 — Additional rules for payment of anesthesia services
• § 414.48 — Limits on actual charges of nonparticipating suppliers
• § 414.50 — Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing physician or other supplier
• § 414.52 — Payment for physician assistants' services
• § 414.53 — Fee schedule for clinical social worker, marriage and family therapist, and mental health counselor services
• § 414.54 — Payment for certified nurse-midwives' services
• § 414.56 — Payment for nurse practitioners' and clinical nurse specialists' services
• § 414.58 — Payment of charges for physician services to patients in providers
• § 414.60 — Payment for the services of CRNAs
• § 414.61 — Payment for anesthesia services furnished by a teaching CRNA
• § 414.62 — Fee schedule for clinical psychologist services
• § 414.63 — Payment for outpatient diabetes self-management training
• § 414.64 — Payment for medical nutrition therapy
• § 414.65 — Payment for telehealth services
• § 414.66 — Incentive payments for physician scarcity areas
• § 414.67 — Incentive payments for services furnished in Health Professional Shortage Areas
• § 414.68 — Imaging accreditation
• § 414.80 — Incentive payment for primary care services
• § 414.84 — Payment for MDPP services
• § 414.90 — Physician Quality Reporting System (PQRS)
• § 414.92 — Electronic Prescribing Incentive Program
• § 414.94 — [Reserved]
• § 414.100 — Purpose
• § 414.102 — General payment rules
• § 414.104 — PEN Items and Services
• § 414.105 — Application of competitive bidding information
• § 414.106 — Splints and casts
• § 414.108 — IOLs inserted in a physician's office
• § 414.110 — Continuity of pricing when HCPCS codes are divided or combined
• § 414.112 — Establishing fee schedule amounts for new HCPCS codes for items and services without a fee schedule pricing history
• § 414.114 — Procedures for making benefit category determinations and payment determinations for new PEN items and services covered under the prosthetic device benefit; splints and casts; and IOLs inserted in a physician's office covered under the prosthetic device benefit
• § 414.200 — Purpose
• § 414.202 — Definitions
• § 414.210 — General payment rules
• § 414.220 — Inexpensive or routinely purchased items
• § 414.222 — Items requiring frequent and substantial servicing
• § 414.224 — Customized items
• § 414.226 — Oxygen and oxygen equipment
• § 414.228 — Prosthetic and orthotic devices
• § 414.229 — Other durable medical equipment—capped rental items
• § 414.230 — Determining a period of continuous use
• § 414.232 — Special payment rules for transcutaneous electrical nerve stimulators (TENS)
• § 414.234 — Prior authorization for items frequently subject to unnecessary utilization
• § 414.236 — Continuity of pricing when HCPCS codes are divided or combined
• § 414.238 — Establishing fee schedule amounts for new HCPCS codes for items and services without a fee schedule pricing history
• § 414.240 — Procedures for making benefit category determinations and payment determinations for new durable medical equipment, prosthetic devices, orthotics and prosthetics, surgical dressings, and therapeutic shoes and inserts
• § 414.300 — Scope of subpart
• § 414.310 — Determination of reasonable charges for physician services furnished to renal dialysis patients
• § 414.313 — Initial method of payment
• § 414.314 — Monthly capitation payment method
• § 414.316 — Payment for physician services to patients in training for self-dialysis and home dialysis
• § 414.320 — Determination of reasonable charges for physician renal transplantation services
• § 414.330 — Payment for home dialysis equipment, supplies, and support services
• § 414.335 — Payment for EPO furnished to a home dialysis patient for use in the home
• § 414.400 — Purpose and basis
• § 414.402 — Definitions
• § 414.404 — Scope and applicability
• § 414.406 — Implementation of programs
• § 414.408 — Payment rules
• § 414.409 — Special payment rules
• § 414.410 — Phased-in implementation of competitive bidding programs
• § 414.411 — Special rule in case of competitions for diabetic testing strips conducted on or after January 1, 2011
• § 414.412 — Submission of bids under a competitive bidding program
• § 414.414 — Conditions for awarding contracts
• § 414.416 — Determination of competitive bidding payment amounts
• § 414.418 — Opportunity for networks
• § 414.420 — Physician or treating practitioner authorization and consideration of clinical efficiency and value of items
• § 414.422 — Terms of contracts
• § 414.423 — Appeals process for breach of a DMEPOS competitive bidding program contract actions
• § 414.424 — Administrative or judicial review
• § 414.425 — Claims for damages
• § 414.426 — Adjustments to competitively bid payment amounts to reflect changes in the HCPCS
• § 414.500 — Basis and scope
• § 414.502 — Definitions
• § 414.504 — Data reporting requirements
• § 414.506 — Procedures for public consultation for payment for a new clinical diagnostic laboratory test
• § 414.507 — Payment for clinical diagnostic laboratory tests
• § 414.508 — Payment for a new clinical diagnostic laboratory test
• § 414.509 — Reconsideration of basis for and amount of payment for a new clinical diagnostic laboratory test
• § 414.510 — Laboratory date of service for clinical laboratory and pathology specimens
• § 414.522 — Payment for new advanced diagnostic laboratory tests
• § 414.523 — Payment for laboratory specimen collection fee and travel allowance
• § 414.601 — Purpose
• § 414.605 — Definitions
• § 414.610 — Basis of payment
• § 414.615 — Transition to the ambulance fee schedule
• § 414.617 — Transition from regional to national ambulance fee schedule
• § 414.620 — Publication of the ambulance fee schedule
• § 414.625 — Limitation on review
• § 414.626 — Data reporting by ground ambulance organizations
• § 414.701 — Purpose
• § 414.704 — Definitions
• § 414.707 — Basis of payment
• § 414.800 — Purpose
• § 414.802 — Definitions
• § 414.804 — Basis of payment
• § 414.806 — Penalties associated with misrepresentation and the failure to submit timely and accurate ASP data
• § 414.900 — Basis and scope
• § 414.902 — Definitions
• § 414.904 — Average sales price as the basis for payment
• § 414.906 — Competitive acquisition program as the basis for payment
• § 414.908 — Competitive acquisition program
• § 414.910 — Bidding process
• § 414.912 — Conflicts of interest
• § 414.914 — Terms of contract
• § 414.916 — Dispute resolution for vendors and beneficiaries
• § 414.917 — Dispute resolution and process for suspension or termination of approved CAP contract and termination of physician participation under exigent circumstances
• § 414.918 — Assignment
• § 414.920 — Judicial review
• § 414.930 — Compendia for determination of medically-accepted indications for off-label uses of drugs and biologicals in an anti-cancer chemotherapeutic regimen
• § 414.940 — Refund for certain discarded single-dose container or single-use package drugs
• § 414.1000 — Purpose
• § 414.1001 — Basis of payment
• § 414.1100 — Basis and scope
• § 414.1105 — Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) services
• § 414.1200 — Basis and scope
• § 414.1205 — Definitions
• § 414.1210 — Application of the value-based payment modifier
• § 414.1215 — Performance and payment adjustment periods for the value-based payment modifier
• § 414.1220 — Reporting mechanisms for the value-based payment modifier
• § 414.1225 — Alignment of Physician Quality Reporting System quality measures and quality measures for the value-based payment modifier
• § 414.1230 — Additional measures for groups and solo practitioners
• § 414.1235 — Cost measures
• § 414.1240 — Attribution for quality of care and cost measures
• § 414.1245 — Scoring methods for the value-based payment modifier using the quality-tiering approach
• § 414.1250 — Benchmarks for quality of care measures
• § 414.1255 — Benchmarks for cost measures
• § 414.1260 — Composite scores
• § 414.1265 — Reliability of measures
• § 414.1270 — Determination and calculation of Value-Based Payment Modifier adjustments
• § 414.1275 — Value-based payment modifier quality-tiering scoring methodology
• § 414.1280 — Limitation on review
• § 414.1285 — Informal inquiry process
• § 414.1300 — Basis and scope
• § 414.1305 — Definitions
• § 414.1310 — Applicability
• § 414.1315 — Virtual groups
• § 414.1317 — APM Entity groups
• § 414.1318 — Subgroups
• § 414.1320 — MIPS performance period
• § 414.1325 — Data submission requirements
• § 414.1330 — Quality performance category
• § 414.1335 — Data submission criteria for the quality performance category
• § 414.1340 — Data completeness criteria for the quality performance category
• § 414.1350 — Cost performance category
• § 414.1355 — Improvement activities performance category
• § 414.1360 — Data submission criteria for the improvement activities performance category
• § 414.1365 — MIPS Value Pathways
• § 414.1367 — APM performance pathway
• § 414.1370 — APM scoring standard under MIPS
• § 414.1375 — Promoting Interoperability (PI) performance category
• § 414.1380 — Scoring
• § 414.1385 — Targeted review and review limitations
• § 414.1390 — Data validation and auditing
• § 414.1395 — Public reporting
• § 414.1400 — Third party intermediaries
• § 414.1405 — Payment
• § 414.1410 — Advanced APM determination
• § 414.1415 — Advanced APM criteria
• § 414.1420 — Other payer advanced APM criteria
• § 414.1425 — Qualifying APM participant determination: In general
• § 414.1430 — Qualifying APM participant determination: QP and partial QP thresholds
• § 414.1435 — Qualifying APM participant determination: Medicare option
• § 414.1440 — Qualifying APM participant determination: All-payer combination option
• § 414.1445 — Determination of other payer advanced APMs
• § 414.1450 — APM incentive payment
• § 414.1455 — Limitation on review
• § 414.1460 — Monitoring and program integrity
• § 414.1465 — Physician-focused payment models
• § 414.1500 — Basis, purpose, and scope
• § 414.1505 — Requirement for payment
• § 414.1510 — Beneficiary qualifications for coverage of services
• § 414.1515 — Plan of care requirements
• § 414.1550 — Basis of payment
• § 414.1600 — Purpose and definitions
• § 414.1650 — Payment basis for lymphedema compression treatment items
• § 414.1660 — Continuity of pricing when HCPCS codes are divided or combined
• § 414.1670 — Procedures for making benefit category determinations and payment determinations for new lymphedema compression treatment items
• § 414.1680 — Frequency limitations
• § 414.1690 — Application of competitive bidding information
• § 414.1700 — Basis of payment

PART 415

• § 415.1 — Basis and scope
• § 415.50 — Scope
• § 415.55 — General payment rules
• § 415.60 — Allocation of physician compensation costs
• § 415.70 — Limits on compensation for physician services in providers
• § 415.100 — Scope
• § 415.102 — Conditions for fee schedule payment for physician services to beneficiaries in providers
• § 415.105 — Amounts of payment for physician services to beneficiaries in providers
• § 415.110 — Conditions for payment: Medically directed anesthesia services
• § 415.120 — Conditions for payment: Radiology services
• § 415.130 — Conditions for payment: Physician pathology services
• § 415.140 — Conditions for payment: Split (or shared) visits
• § 415.150 — Scope
• § 415.152 — Definitions
• § 415.160 — Election of reasonable cost payment for direct medical and surgical services of physicians in teaching hospitals: General provisions
• § 415.162 — Determining payment for physician services furnished to beneficiaries in teaching hospitals
• § 415.164 — Payment to a fund
• § 415.170 — Conditions for payment on a fee schedule basis for physician services in a teaching setting
• § 415.172 — Physician fee schedule payment for services of teaching physicians
• § 415.174 — Exception: Evaluation and management services furnished in certain centers
• § 415.176 — Renal dialysis services
• § 415.178 — Anesthesia services
• § 415.180 — Teaching setting requirements for the interpretation of diagnostic radiology and other diagnostic tests
• § 415.184 — Psychiatric services
• § 415.190 — Conditions of payment: Assistants at surgery in teaching hospitals
• § 415.200 — Services of residents in approved GME programs
• § 415.202 — Services of residents not in approved GME programs
• § 415.204 — Services of residents in skilled nursing facilities and home health agencies
• § 415.206 — Services of residents in nonprovider settings
• § 415.208 — Services of moonlighting residents

PART 416

• § 416.1 — Basis and scope
• § 416.2 — Definitions
• § 416.25 — Basic requirements
• § 416.26 — Qualifying for an agreement
• § 416.30 — Terms of agreement with CMS
• § 416.35 — Termination of agreement
• § 416.40 — Condition for coverage—Compliance with State licensure law
• § 416.41 — Condition for coverage—Governing body and management
• § 416.42 — Condition for coverage—Surgical services
• § 416.43 — Conditions for coverage—Quality assessment and performance improvement
• § 416.44 — Condition for coverage—Environment
• § 416.45 — Condition for coverage—Medical staff
• § 416.46 — Condition for coverage—Nursing services
• § 416.47 — Condition for coverage—Medical records
• § 416.48 — Condition for coverage—Pharmaceutical services
• § 416.49 — Condition for coverage—Laboratory and radiologic services
• § 416.50 — Condition for coverage—Patient rights
• § 416.51 — Conditions for coverage—Infection control
• § 416.52 — Conditions for coverage—Patient admission, assessment and discharge
• § 416.54 — Condition for coverage—Emergency preparedness
• § 416.60 — General rules
• § 416.61 — Scope of facility services
• § 416.65 — Covered surgical procedures
• § 416.75 — Performance of listed surgical procedures on an inpatient hospital basis
• § 416.76 — Applicability
• § 416.120 — Basis for payment
• § 416.121 — Applicability
• § 416.125 — ASC facility services payment rate
• § 416.130 — Publication of revised payment methodologies
• § 416.140 — Surveys
• § 416.160 — Basis and scope
• § 416.161 — Applicability of this subpart
• § 416.163 — General rules
• § 416.164 — Scope of ASC services
• § 416.166 — Covered surgical procedures
• § 416.167 — Basis of payment
• § 416.171 — Determination of payment rates for ASC services
• § 416.172 — Adjustments to national payment rates
• § 416.173 — Publication of revised payment methodologies and payment rates
• § 416.174 — Payment for non-opioid pain management drugs, biologicals, and medical devices
• § 416.178 — Limitations on administrative and judicial review
• § 416.179 — Payment and coinsurance reduction for devices replaced without cost or when full or partial credit is received
• § 416.180 — Basis and scope
• § 416.185 — Process for establishing a new class of new technology IOLs
• § 416.190 — Request for review of payment amount
• § 416.195 — Determination of membership in new classes of new technology IOLs
• § 416.200 — Payment adjustment
• § 416.300 — Basis and scope of subpart
• § 416.305 — Participation and withdrawal requirements under the ASCQR Program
• § 416.310 — Data collection and submission requirements under the ASCQR Program
• § 416.315 — Public reporting of data under the ASCQR Program
• § 416.320 — Retention and removal of quality measures under the ASCQR Program
• § 416.325 — Measure maintenance under the ASCQR Program
• § 416.330 — Reconsiderations under the ASCQR Program

PART 417

• § 417.1 — Definitions
• § 417.2 — Basis and scope
• § 417.101 — Health benefits plan: Basic health services
• § 417.102 — Health benefits plan: Supplemental health services
• § 417.103 — Providers of basic and supplemental health services
• § 417.104 — Payment for basic health services
• § 417.105 — Payment for supplemental health services
• § 417.106 — Quality assurance program; Availability, accessibility, and continuity of basic and supplemental health services
• § 417.120 — Fiscally sound operation and assumption of financial risk
• § 417.122 — Protection of enrollees
• § 417.124 — Administration and management
• § 417.126 — Recordkeeping and reporting requirements
• § 417.140 — Scope
• § 417.142 — Requirements for qualification
• § 417.143 — Application requirements
• § 417.144 — Evaluation and determination procedures
• § 417.150 — Definitions
• § 417.151 — Applicability
• § 417.153 — Offer of HMO alternative
• § 417.155 — How the HMO option must be included in the health benefits plan
• § 417.156 — When the HMO must be offered to employees
• § 417.157 — Contributions for the HMO alternative
• § 417.158 — Payroll deductions
• § 417.159 — Relationship of section 1310 of the Public Health Service Act to the National Labor Relations Act and the Railway Labor Act
• § 417.160 — Applicability
• § 417.161 — Compliance with assurances
• § 417.162 — Reporting requirements
• § 417.163 — Enforcement procedures
• § 417.164 — Effect of revocation of qualification on inclusion in employee's health benefit plans
• § 417.165 — Reapplication for qualification
• § 417.166 — Waiver of assurances
• § 417.400 — Basis and scope
• § 417.401 — Definitions
• § 417.402 — Effective date of initial regulations
• § 417.404 — General requirements
• § 417.406 — Application and determination
• § 417.407 — Requirements for a Competitive Medical Plan (CMP)
• § 417.408 — Contract application process
• § 417.410 — Qualifying conditions: General rules
• § 417.412 — Qualifying condition: Administration and management
• § 417.413 — Qualifying condition: Operating experience and enrollment
• § 417.414 — Qualifying condition: Range of services
• § 417.416 — Qualifying condition: Furnishing of services
• § 417.418 — Qualifying condition: Quality assurance program
• § 417.420 — Basic rules on enrollment and entitlement
• § 417.422 — Eligibility to enroll in an HMO or CMP
• § 417.423 — Special rules: ESRD and hospice patients
• § 417.424 — Denial of enrollment
• § 417.426 — Open enrollment requirements
• § 417.427 — Extending MA and Part D program disclosure requirements to section 1876 cost contract plans
• § 417.428 — Marketing activities
• § 417.430 — Application procedures
• § 417.432 — Conversion of enrollment
• § 417.434 — Reenrollment
• § 417.436 — Rules for enrollees
• § 417.440 — Entitlement to health care services from an HMO or CMP
• § 417.442 — Risk HMO's and CMP's: Conditions for provision of additional benefits
• § 417.444 — Special rules for certain enrollees of risk HMOs and CMPs
• § 417.446 — [Reserved]
• § 417.448 — Restriction on payments for services received by Medicare enrollees of risk HMOs or CMPs
• § 417.450 — Effective date of coverage
• § 417.452 — Liability of Medicare enrollees
• § 417.454 — Charges to Medicare enrollees
• § 417.456 — Refunds to Medicare enrollees
• § 417.458 — Recoupment of uncollected deductible and coinsurance amounts
• § 417.460 — Disenrollment of beneficiaries by an HMO or CMP
• § 417.461 — Disenrollment by the enrollee
• § 417.464 — End of CMS's liability for payment: Disenrollment of beneficiaries and termination or default of contract
• § 417.470 — Basis and scope
• § 417.472 — Basic contract requirements
• § 417.474 — Effective date and term of contract
• § 417.476 — Waived conditions
• § 417.478 — Requirements of other laws and regulations
• § 417.479 — Requirements for physician incentive plans
• § 417.480 — Maintenance of records: Cost HMOs and CMPs
• § 417.481 — Maintenance of records: Risk HMOs and CMPs
• § 417.482 — Access to facilities and records
• § 417.484 — Requirement applicable to related entities
• § 417.486 — Disclosure of information and confidentiality
• § 417.488 — Notice of termination and of available alternatives: Risk contract
• § 417.490 — Renewal of contract
• § 417.492 — Nonrenewal of contract
• § 417.494 — Modification or termination of contract
• § 417.496 — Cost plan crosswalk
• § 417.500 — Intermediate sanctions for and civil monetary penalties against HMOs and CMPs
• § 417.520 — Effect on HMO and CMP contracts
• § 417.524 — Payment to HMOs or CMPs: General
• § 417.526 — Payment for covered services
• § 417.528 — Payment when Medicare is not primary payer
• § 417.530 — Basis and scope
• § 417.531 — Hospice care services
• § 417.532 — General considerations
• § 417.533 — Part B carrier responsibilities
• § 417.534 — Allowable costs
• § 417.536 — Cost payment principles
• § 417.538 — Enrollment and marketing costs
• § 417.540 — Enrollment costs
• § 417.542 — Reinsurance costs
• § 417.544 — Physicians' services furnished directly by the HMO or CMP
• § 417.546 — Physicians' services and other Part B supplier services furnished under arrangements
• § 417.548 — Provider services through arrangements
• § 417.550 — Special Medicare program requirements
• § 417.552 — Cost apportionment: General provisions
• § 417.554 — Apportionment: Provider services furnished directly by the HMO or CMP
• § 417.556 — Apportionment: Provider services furnished by the HMO or CMP through arrangements with others
• § 417.558 — Emergency, urgently needed, and out-of-area services for which the HMO or CMP accepts responsibility
• § 417.560 — Apportionment: Part B physician and supplier services
• § 417.564 — Apportionment and allocation of administrative and general costs
• § 417.566 — Other methods of allocation and apportionment
• § 417.568 — Adequate financial records, statistical data, and cost finding
• § 417.570 — Interim per capita payments
• § 417.572 — Budget and enrollment forecast and interim reports
• § 417.574 — Interim settlement
• § 417.576 — Final settlement
• § 417.580 — Basis and scope
• § 417.582 — Definitions
• § 417.584 — Payment to HMOs or CMPs with risk contracts
• § 417.585 — Special rules: Hospice care
• § 417.588 — Computation of adjusted average per capita cost (AAPCC)
• § 417.590 — Computation of the average of the per capita rates of payment
• § 417.592 — Additional benefits requirement
• § 417.594 — Computation of adjusted community rate (ACR)
• § 417.596 — Establishment of a benefit stabilization fund
• § 417.597 — Withdrawal from a benefit stabilization fund
• § 417.598 — Annual enrollment reconciliation
• § 417.600 — Basis and scope
• § 417.640 — Applicability
• § 417.800 — Payment to HCPPs: Definitions and basic rules
• § 417.801 — Agreements between CMS and health care prepayment plans
• § 417.802 — Allowable costs
• § 417.804 — Cost apportionment
• § 417.806 — Financial records, statistical data, and cost finding
• § 417.808 — Interim per capita payments
• § 417.810 — Final settlement
• § 417.830 — Scope of regulations on beneficiary appeals
• § 417.832 — Applicability of requirements and procedures
• § 417.834 — Responsibility for establishing administrative review procedures
• § 417.836 — Written description of administrative review procedures
• § 417.838 — Organization determinations
• § 417.840 — Administrative review procedures
• § 417.910 — Applicability
• § 417.911 — Definitions
• § 417.920 — Planning and initial development
• § 417.930 — Initial costs of operation
• § 417.931 — [Reserved]
• § 417.934 — Reserve requirement
• § 417.937 — Loan and loan guarantee provisions
• § 417.940 — Civil action to enforce compliance with assurances

PART 418

• § 418.1 — Statutory basis
• § 418.2 — Scope of part
• § 418.3 — Definitions
• § 418.20 — Eligibility requirements
• § 418.21 — Duration of hospice care coverage—Election periods
• § 418.22 — Certification of terminal illness
• § 418.24 — Election of hospice care
• § 418.25 — Admission to hospice care
• § 418.26 — Discharge from hospice care
• § 418.28 — Revoking the election of hospice care
• § 418.30 — Change of the designated hospice
• § 418.52 — Condition of participation: Patient's rights
• § 418.54 — Condition of participation: Initial and comprehensive assessment of the patient
• § 418.56 — Condition of participation: Interdisciplinary group, care planning, and coordination of services
• § 418.58 — Condition of participation: Quality assessment and performance improvement
• § 418.60 — Condition of participation: Infection control
• § 418.62 — Condition of participation: Licensed professional services
• § 418.64 — Condition of participation: Core services
• § 418.66 — Condition of participation: Nursing services—Waiver of requirement that substantially all nursing services be routinely provided directly by a hospice
• § 418.70 — Condition of participation: Furnishing of non-core services
• § 418.72 — Condition of participation: Physical therapy, occupational therapy, and speech-language pathology
• § 418.74 — Waiver of requirement—Physical therapy, occupational therapy, speech-language pathology, and dietary counseling
• § 418.76 — Condition of participation: Hospice aide and homemaker services
• § 418.78 — Conditions of participation—Volunteers
• § 418.100 — Condition of Participation: Organization and administration of services
• § 418.102 — Condition of participation: Medical director
• § 418.104 — Condition of participation: Clinical records
• § 418.106 — Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment
• § 418.108 — Condition of participation: Short-term inpatient care
• § 418.110 — Condition of participation: Hospices that provide inpatient care directly
• § 418.112 — Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID
• § 418.113 — Condition of participation: Emergency preparedness
• § 418.114 — Condition of participation: Personnel qualifications
• § 418.116 — Condition of participation: Compliance with Federal, State, and local laws and regulations related to the health and safety of patients
• § 418.200 — Requirements for coverage
• § 418.202 — Covered services
• § 418.204 — Special coverage requirements
• § 418.205 — Special requirements for hospice pre-election evaluation and counseling services
• § 418.301 — Basic rules
• § 418.302 — Payment procedures for hospice care
• § 418.304 — Payment for physician, and nurse practitioner, and physician assistant services
• § 418.306 — Annual update of the payment rates and adjustment for area wage differences
• § 418.307 — Periodic interim payments
• § 418.308 — Limitation on the amount of hospice payments
• § 418.309 — Hospice aggregate cap
• § 418.310 — Reporting and recordkeeping requirements
• § 418.311 — Administrative appeals
• § 418.312 — Data submission requirements under the hospice quality reporting program
• § 418.400 — Individual liability for coinsurance for hospice care
• § 418.402 — Individual liability for services that are not considered hospice care
• § 418.405 — Effect of coinsurance liability on Medicare payment

PART 419

• § 419.1 — Basis and scope
• § 419.2 — Basis of payment
• § 419.20 — Hospitals subject to the hospital outpatient prospective payment system
• § 419.21 — Hospital services subject to the outpatient prospective payment system
• § 419.22 — Hospital services excluded from payment under the hospital outpatient prospective payment system
• § 419.30 — Base expenditure target for calendar year 1999
• § 419.31 — Ambulatory payment classification (APC) system and payment weights
• § 419.32 — Calculation of prospective payment rates for hospital outpatient services
• § 419.40 — Payment concepts
• § 419.41 — Calculation of national beneficiary copayment amounts and national Medicare program payment amounts
• § 419.42 — Hospital election to reduce coinsurance
• § 419.43 — Adjustments to national program payment and beneficiary copayment amounts
• § 419.44 — Payment reductions for procedures
• § 419.45 — Payment and copayment reduction for devices replaced without cost or when full or partial credit is received
• § 419.46 — Requirements under the Hospital Outpatient Quality Reporting (OQR) Program
• § 419.47 — Coding and payment for Category B Investigational Device Exemption (IDE) studies
• § 419.48 — Definition of excepted items and services
• § 419.49 — Additional payment for technetium-99m (Tc-99m) derived from domestically produced molybdenum-99 (Mo-99)
• § 419.50 — Annual review
• § 419.60 — Limitations on administrative and judicial review
• § 419.62 — Transitional pass-through payments: General rules
• § 419.64 — Transitional pass-through payments: Drugs and biologicals
• § 419.66 — Transitional pass-through payments: Medical devices
• § 419.70 — Transitional adjustments to limit decline in payments
• § 419.71 — Payment reduction for certain X-ray imaging services
• § 419.80 — Basis and scope of this subpart
• § 419.81 — Definitions
• § 419.82 — Prior authorization for certain covered hospital outpatient department services
• § 419.83 — List of hospital outpatient department services requiring prior authorization
• § 419.84-419.89 — 419.84-419.89 [Reserved]
• § 419.90 — Basis and scope of subpart
• § 419.91 — Definitions
• § 419.92 — Payment to rural emergency hospitals
• § 419.93 — Payment for an off-campus provider-based department of a rural emergency hospital
• § 419.94 — Preclusion of administrative and judicial review
• § 419.95 — Requirements under the Rural Emergency Hospital Quality Reporting (REHQR) Program

PART 420

• § 420.1 — Scope and purpose
• § 420.3 — Other related regulations
• § 420.200 — Purpose
• § 420.201 — Definitions
• § 420.202 — Determination of ownership or control percentages
• § 420.203 — Disclosure of hiring of intermediary's former employees
• § 420.204 — Principals convicted of a program-related crime
• § 420.205 — Disclosure by providers and part B suppliers of business transaction information
• § 420.206 — Disclosure of persons having ownership, financial, or control interest
• § 420.300 — Basis, purpose, and scope
• § 420.301 — Definitions
• § 420.302 — Requirement for access clause in contracts
• § 420.303 — HHS criteria for requesting books, documents, and records
• § 420.304 — Procedures for obtaining access to books, documents, and records
• § 420.400 — Basis and scope
• § 420.405 — Rewards for information relating to Medicare fraud and abuse
• § 420.410 — Establishment of a program to collect suggestions for improving Medicare program efficiency and to reward suggesters for monetary savings

PART 421

• § 421.1 — Basis, applicability, and scope
• § 421.3 — Definitions
• § 421.5 — General provisions
• § 421.100 — Intermediary functions
• § 421.103 — Payment to providers
• § 421.104 — Assignment of providers of services to intermediaries during transition to Medicare Administrative Contractors (MACs)
• § 421.110 — Requirements for approval of an agreement
• § 421.112 — Considerations relating to the effective and efficient administration of the program
• § 421.114 — Assignment and reassignment of providers by CMS
• § 421.120 — Performance criteria
• § 421.122 — Performance standards
• § 421.124 — Intermediary's failure to perform efficiently and effectively
• § 421.126 — Termination of agreements
• § 421.128 — Intermediary's opportunity for hearing and right to judicial review
• § 421.200 — Carrier functions
• § 421.201 — Performance criteria and standards
• § 421.202 — Requirements and conditions
• § 421.203 — Carrier's failure to perform efficiently and effectively
• § 421.205 — Termination by the Secretary
• § 421.210 — Designations of regional carriers to process claims for durable medical equipment, prosthetics, orthotics and supplies
• § 421.212 — Railroad Retirement Board contracts
• § 421.214 — Advance payments to suppliers furnishing items or services under Part B
• § 421.300 — Basis, applicability, and scope
• § 421.302 — Eligibility requirements for Medicare integrity program contractors
• § 421.304 — Medicare integrity program contractor functions
• § 421.306 — Awarding of a contract
• § 421.308 — Renewal of a contract
• § 421.310 — Conflict of interest requirements
• § 421.312 — Conflict of interest resolution
• § 421.316 — Limitation on Medicare integrity program contractor liability
• § 421.400 — Statutory basis and scope
• § 421.401 — Definitions
• § 421.404 — Assignment of providers and suppliers to MACs

PART 422

• § 422.1 — Basis and scope
• § 422.2 — Definitions
• § 422.3 — MA organizations' use of reinsurance
• § 422.4 — Types of MA plans
• § 422.6 — Cost-sharing in enrollment-related costs
• § 422.50 — Eligibility to elect an MA plan
• § 422.52 — Eligibility to elect an MA plan for special needs individuals
• § 422.53 — Eligibility to elect an MA plan for senior housing facility residents
• § 422.54 — Continuation of enrollment for MA local plans
• § 422.56 — Enrollment in an MA MSA plan
• § 422.57 — Limited enrollment under MA RFB plans
• § 422.60 — Election process
• § 422.62 — Election of coverage under an MA plan
• § 422.64 — Information about the MA program
• § 422.66 — Coordination of enrollment and disenrollment through MA organizations
• § 422.68 — Effective dates of coverage and change of coverage
• § 422.74 — Disenrollment by the MA organization
• § 422.100 — General requirements
• § 422.101 — Requirements relating to basic benefits
• § 422.102 — Supplemental benefits
• § 422.103 — Benefits under an MA MSA plan
• § 422.104 — Special rules on supplemental benefits for MA MSA plans
• § 422.105 — Special rules for self-referral and point of service option
• § 422.106 — Coordination of benefits with employer or union group health plans and Medicaid
• § 422.107 — Requirements for dual eligible special needs plans
• § 422.108 — Medicare secondary payer (MSP) procedures
• § 422.109 — Effect of national coverage determinations (NCDs) and legislative changes in benefits; coverage of clinical trials and A and B device trials
• § 422.110 — Discrimination against beneficiaries prohibited
• § 422.111 — Disclosure requirements
• § 422.112 — Access to services
• § 422.113 — Special rules for ambulance services, emergency and urgently needed services, and maintenance and post-stabilization care services
• § 422.114 — Access to services under an MA private fee-for-service plan
• § 422.116 — Network adequacy
• § 422.118 — Confidentiality and accuracy of enrollee records
• § 422.119 — Access to and exchange of health data and plan information
• § 422.120 — Access to published provider directory information
• § 422.121 — Access to and exchange of health data for providers and payers
• § 422.122 — Prior authorization requirements
• § 422.125 — Resolution of complaints in a Complaints Tracking Module
• § 422.128 — Information on advance directives
• § 422.132 — Protection against liability and loss of benefits
• § 422.133 — Return to home skilled nursing facility
• § 422.134 — Reward and incentive programs
• § 422.135 — Additional telehealth benefits
• § 422.136 — Medicare Advantage (MA) and step therapy for Part B drugs
• § 422.137 — Medicare Advantage Utilization Management Committee
• § 422.138 — Prior authorization
• § 422.152 — Quality improvement program
• § 422.153 — Use of quality improvement organization review information
• § 422.156 — Compliance deemed on the basis of accreditation
• § 422.157 — Accreditation organizations
• § 422.158 — Procedures for approval of accreditation as a basis for deeming compliance
• § 422.160 — Basis and scope of the Medicare Advantage Quality Rating System
• § 422.162 — Medicare Advantage Quality Rating System
• § 422.164 — Adding, updating, and removing measures
• § 422.166 — Calculation of Star Ratings
• § 422.200 — Basis and scope
• § 422.202 — Participation procedures
• § 422.204 — Provider selection and credentialing
• § 422.205 — Provider antidiscrimination rules
• § 422.206 — Interference with health care professionals' advice to enrollees prohibited
• § 422.208 — Physician incentive plans: requirements and limitations
• § 422.210 — Assurances to CMS
• § 422.212 — Limitations on provider indemnification
• § 422.214 — Special rules for services furnished by noncontract providers
• § 422.216 — Special rules for MA private fee-for-service plans
• § 422.220 — Exclusion of payment for basic benefits furnished under a private contract
• § 422.222 — Preclusion list for contracted and non-contracted individuals and entities
• § 422.224 — Payment to individuals and entities excluded by the OIG or included on the preclusion list
• § 422.250 — Basis and scope
• § 422.252 — Terminology
• § 422.254 — Submission of bids
• § 422.256 — Review, negotiation, and approval of bids
• § 422.258 — Calculation of benchmarks
• § 422.260 — Appeals of quality bonus payment determinations
• § 422.262 — Beneficiary premiums
• § 422.264 — Calculation of savings
• § 422.266 — Beneficiary rebates
• § 422.270 — Incorrect collections of premiums and cost-sharing
• § 422.272 — Release of MA bid pricing data
• § 422.300 — Basis and scope
• § 422.304 — Monthly payments
• § 422.306 — Annual MA capitation rates
• § 422.308 — Adjustments to capitation rates, benchmarks, bids, and payments
• § 422.310 — Risk adjustment data
• § 422.311 — RADV audit dispute and appeal processes
• § 422.312 — Announcement of annual capitation rate, benchmarks, and methodology changes
• § 422.314 — Special rules for beneficiaries enrolled in MA MSA plans
• § 422.316 — Special rules for payments to Federally qualified health centers
• § 422.318 — Special rules for coverage that begins or ends during an inpatient hospital stay
• § 422.320 — Special rules for hospice care
• § 422.322 — Source of payment and effect of MA plan election on payment
• § 422.324 — Payments to MA organizations for graduate medical education costs
• § 422.326 — Reporting and returning of overpayments
• § 422.330 — CMS-identified overpayments associated with payment data submitted by MA organizations
• § 422.350 — Basis, scope, and definitions
• § 422.352 — Basic requirements
• § 422.354 — Requirements for affiliated providers
• § 422.356 — Determining substantial financial risk and majority financial interest
• § 422.370 — Waiver of State licensure
• § 422.372 — Basis for waiver of State licensure
• § 422.374 — Waiver request and approval process
• § 422.376 — Conditions of the waiver
• § 422.378 — Relationship to State law
• § 422.380 — Solvency standards
• § 422.382 — Minimum net worth amount
• § 422.384 — Financial plan requirement
• § 422.386 — Liquidity
• § 422.388 — Deposits
• § 422.390 — Guarantees
• § 422.400 — State licensure requirement
• § 422.402 — Federal preemption of State law
• § 422.404 — State premium taxes prohibited
• § 422.451 — Moratorium on new local preferred provider organization plans
• § 422.455 — Special rules for MA Regional Plans
• § 422.458 — Risk sharing with regional MA organizations for 2006 and 2007
• § 422.500 — Scope and definitions
• § 422.501 — Application requirements
• § 422.502 — Evaluation and determination procedures
• § 422.503 — General provisions
• § 422.504 — Contract provisions
• § 422.505 — Effective date and term of contract
• § 422.506 — Nonrenewal of contract
• § 422.508 — Modification or termination of contract by mutual consent
• § 422.510 — Termination of contract by CMS
• § 422.512 — Termination of contract by the MA organization
• § 422.514 — Enrollment requirements
• § 422.516 — Validation of Part C reporting requirements
• § 422.520 — Prompt payment by MA organization
• § 422.521 — Effective date of new significant regulatory requirements
• § 422.524 — Special rules for RFB societies
• § 422.527 — Agreements with Federally qualified health centers
• § 422.528 — Final settlement process and payment
• § 422.529 — Requesting an appeal of the final settlement amount
• § 422.530 — Plan crosswalks
• § 422.550 — General provisions
• § 422.552 — Novation agreement requirements
• § 422.553 — Effect of leasing of an MA organization's facilities
• § 422.560 — Basis and scope
• § 422.561 — Definitions
• § 422.562 — General provisions
• § 422.564 — Grievance procedures
• § 422.566 — Organization determinations
• § 422.568 — Standard timeframes and notice requirements for organization determinations
• § 422.570 — Expediting certain organization determinations
• § 422.572 — Timeframes and notice requirements for expedited organization determinations
• § 422.574 — Parties to the organization determination
• § 422.576 — Effect of an organization determination
• § 422.578 — Right to a reconsideration
• § 422.580 — Reconsideration defined
• § 422.582 — Request for a standard reconsideration
• § 422.584 — Expediting certain reconsiderations
• § 422.586 — Opportunity to submit evidence
• § 422.590 — Timeframes and responsibility for reconsiderations
• § 422.592 — Reconsideration by an independent entity
• § 422.594 — Notice of reconsidered determination by the independent entity
• § 422.596 — Effect of a reconsidered determination
• § 422.600 — Right to a hearing
• § 422.602 — Request for an ALJ hearing
• § 422.608 — Medicare Appeals Council (Council) review
• § 422.612 — Judicial review
• § 422.616 — Reopening and revising determinations and decisions
• § 422.618 — How an MA organization must effectuate standard reconsidered determinations or decisions
• § 422.619 — How an MA organization must effectuate expedited reconsidered determinations
• § 422.620 — Notifying enrollees of hospital discharge appeal rights
• § 422.622 — Requesting immediate QIO review of the decision to discharge from the inpatient hospital
• § 422.624 — Notifying enrollees of termination of provider services
• § 422.626 — Fast-track appeals of service terminations to independent review entities (IREs)
• § 422.629 — General requirements for applicable integrated plans
• § 422.630 — Integrated grievances
• § 422.631 — Integrated organization determinations
• § 422.632 — Continuation of benefits while the applicable integrated plan reconsideration is pending
• § 422.633 — Integrated reconsiderations
• § 422.634 — Effect
• § 422.641 — Contract determinations
• § 422.644 — Notice of contract determination
• § 422.646 — Effect of contract determination
• § 422.660 — Right to a hearing, burden of proof, standard of proof, and standards of review
• § 422.662 — Request for hearing
• § 422.664 — Postponement of effective date of a contract determination when a request for a hearing is filed timely
• § 422.666 — Designation of hearing officer
• § 422.668 — Disqualification of hearing officer
• § 422.670 — Time and place of hearing
• § 422.672 — Appointment of representatives
• § 422.674 — Authority of representatives
• § 422.676 — Conduct of hearing
• § 422.678 — Evidence
• § 422.680 — Witnesses
• § 422.682 — Witness lists and documents
• § 422.684 — Prehearing and summary judgment
• § 422.686 — Record of hearing
• § 422.688 — Authority of hearing officer
• § 422.690 — Notice and effect of hearing decision
• § 422.692 — Review by the Administrator
• § 422.694 — Effect of Administrator's decision
• § 422.696 — Reopening of a contract determination or decision of a hearing officer or the Administrator
• § 422.750 — Types of intermediate sanctions and civil money penalties
• § 422.752 — Basis for imposing intermediate sanctions and civil money penalties
• § 422.756 — Procedures for imposing intermediate sanctions and civil money penalties
• § 422.758 — Collection of civil money penalties imposed by CMS
• § 422.760 — Determinations regarding the amount of civil money penalties and assessment imposed by CMS
• § 422.762 — Settlement of penalties
• § 422.764 — Other applicable provisions
• § 422.1000 — Basis and scope
• § 422.1002 — Definitions
• § 422.1004 — Scope and applicability
• § 422.1006 — Appeal rights
• § 422.1008 — Appointment of representatives
• § 422.1010 — Authority of representatives
• § 422.1012 — Fees for services of representatives
• § 422.1014 — Charge for transcripts
• § 422.1016 — Filing of briefs with the Administrative Law Judge or Departmental Appeals Board, and opportunity for rebuttal
• § 422.1018 — Notice and effect of initial determinations
• § 422.1020 — Request for hearing
• § 422.1022 — Parties to the hearing
• § 422.1024 — Designation of hearing official
• § 422.1026 — Disqualification of Administrative Law Judge
• § 422.1028 — Prehearing conference
• § 422.1030 — Notice of prehearing conference
• § 422.1032 — Conduct of prehearing conference
• § 422.1034 — Record, order, and effect of prehearing conference
• § 422.1036 — Time and place of hearing
• § 422.1038 — Change in time and place of hearing
• § 422.1040 — Joint hearings
• § 422.1042 — Hearing on new issues
• § 422.1044 — Subpoenas
• § 422.1046 — Conduct of hearing
• § 422.1048 — Evidence
• § 422.1050 — Witnesses
• § 422.1052 — Oral and written summation
• § 422.1054 — Record of hearing
• § 422.1056 — Waiver of right to appear and present evidence
• § 422.1058 — Dismissal of request for hearing
• § 422.1060 — Dismissal for abandonment
• § 422.1062 — Dismissal for cause
• § 422.1064 — Notice and effect of dismissal and right to request review
• § 422.1066 — Vacating a dismissal of request for hearing
• § 422.1068 — Administrative Law Judge's decision
• § 422.1070 — Removal of hearing to Departmental Appeals Board
• § 422.1072 — Remand by the Administrative Law Judge
• § 422.1074 — Right to request Departmental Appeals Board review of Administrative Law Judge's decision or dismissal
• § 422.1076 — Request for Departmental Appeals Board review
• § 422.1078 — Departmental Appeals Board action on request for review
• § 422.1080 — Procedures before the Departmental Appeals Board on review
• § 422.1082 — Evidence admissible on review
• § 422.1084 — Decision or remand by the Departmental Appeals Board
• § 422.1086 — Effect of Departmental Appeals Board Decision
• § 422.1088 — Extension of time for seeking judicial review
• § 422.1090 — Basis, timing, and authority for reopening an Administrative Law Judge or Board decision
• § 422.1092 — Revision of reopened decision
• § 422.1094 — Notice and effect of revised decision
• § 422.2260 — Definitions
• § 422.2261 — Submission, review, and distribution of materials
• § 422.2262 — General communications materials and activities requirements
• § 422.2263 — General marketing requirements
• § 422.2264 — Beneficiary contact
• § 422.2265 — Websites
• § 422.2266 — Activities with healthcare providers or in the healthcare setting
• § 422.2267 — Required materials and content
• § 422.2272 — Licensing of marketing representatives and confirmation of marketing resources
• § 422.2274 — Agent, broker, and other third-party requirements
• § 422.2276 — Employer group retiree marketing
• § 422.2400 — Basis and scope
• § 422.2401 — Definitions
• § 422.2410 — General requirements
• § 422.2420 — Calculation of the medical loss ratio
• § 422.2430 — Activities that improve health care quality
• § 422.2440 — Credibility adjustment
• § 422.2450 — [Reserved]
• § 422.2460 — Reporting requirements
• § 422.2470 — Remittance to CMS if the applicable MLR requirement is not met
• § 422.2480 — MLR review and non-compliance
• § 422.2490 — Release of Part C MLR data
• § 422.2600 — Payment appeals
• § 422.2605 — Request for reconsideration
• § 422.2610 — Hearing official review
• § 422.2615 — Review by the Administrator

PART 423

• § 423.1 — Basis and scope
• § 423.4 — Definitions
• § 423.6 — Cost-sharing in beneficiary education and enrollment-related costs
• § 423.30 — Eligibility and enrollment
• § 423.32 — Enrollment process
• § 423.34 — Enrollment of low-income subsidy eligible individuals
• § 423.36 — Disenrollment process
• § 423.38 — Enrollment periods
• § 423.40 — Effective dates
• § 423.44 — Involuntary disenrollment from Part D coverage
• § 423.46 — Late enrollment penalty
• § 423.48 — Information about Part D
• § 423.56 — Procedures to determine and document creditable status of prescription drug coverage
• § 423.100 — Definitions
• § 423.104 — Requirements related to qualified prescription drug coverage
• § 423.112 — Establishment of prescription drug plan service areas
• § 423.120 — Access to covered Part D drugs
• § 423.124 — Special rules for out-of-network access to covered Part D drugs at out-of-network pharmacies
• § 423.128 — Dissemination of Part D plan information
• § 423.129 — Resolution of complaints in complaints tracking module
• § 423.132 — Public disclosure of pharmaceutical prices for equivalent drugs
• § 423.136 — Privacy, confidentiality, and accuracy of enrollee records
• § 423.137 — Medicare Prescription Payment Plan
• § 423.150 — Scope
• § 423.153 — Drug utilization management, quality assurance, medication therapy management (MTM) programs, drug management programs, and access to Medicare Parts A and B claims data extracts
• § 423.154 — Appropriate dispensing of prescription drugs in long-term care facilities under PDPs and MA-PD plans
• § 423.156 — Consumer satisfaction surveys
• § 423.159 — Electronic prescription drug program
• § 423.160 — Standards for electronic prescribing
• § 423.162 — Quality improvement organization activities
• § 423.165 — Compliance deemed on the basis of accreditation
• § 423.168 — Accreditation organizations
• § 423.171 — Procedures for approval of accreditation as a basis for deeming compliance
• § 423.180 — Basis and scope of the Part D Prescription Drug Plan Quality Rating System
• § 423.182 — Part D Prescription Drug Plan Quality Rating System
• § 423.184 — Adding, updating, and removing measures
• § 423.186 — Calculation of Star Ratings
• § 423.251 — Scope
• § 423.258 — Definitions
• § 423.265 — Submission of bids and related information
• § 423.272 — Review and negotiation of bid and approval of plans submitted by potential Part D sponsors
• § 423.279 — National average monthly bid amount
• § 423.286 — Rules regarding premiums
• § 423.293 — Collection of monthly beneficiary premium
• § 423.294 — Failure to collect and incorrect collections of premiums and cost sharing
• § 423.301 — Scope
• § 423.308 — Definitions and terminology
• § 423.315 — General payment provisions
• § 423.322 — Requirement for disclosure of information
• § 423.325 — PDE submission timeliness requirements
• § 423.329 — Determination of payments
• § 423.336 — Risk-sharing arrangements
• § 423.343 — Retroactive adjustments and reconciliations
• § 423.346 — Reopening
• § 423.350 — Payment appeals
• § 423.352 — CMS-identified overpayments associated with payment data submitted by Part D sponsors
• § 423.360 — Reporting and returning of overpayments
• § 423.401 — General requirements for PDP sponsors
• § 423.410 — Waiver of certain requirements to expand choice
• § 423.415 — Temporary waivers for entities seeking to offer a prescription drug plan in more than one State in a region
• § 423.420 — Solvency standards for non-licensed entities
• § 423.425 — Licensure does not substitute for or constitute certification
• § 423.440 — Prohibition of State imposition of premium taxes; relation to State laws
• § 423.452 — Scope
• § 423.454 — Definitions
• § 423.458 — Application of Part D rules to certain Part D plans on and after January 1, 2006
• § 423.462 — Medicare secondary payer procedures
• § 423.464 — Coordination of benefits with other providers of prescription drug coverage
• § 423.466 — Timeframes for coordination of benefits and claims adjustments
• § 423.500 — Scope
• § 423.501 — Definitions
• § 423.502 — Application requirements
• § 423.503 — Evaluation and determination procedures
• § 423.504 — General provisions
• § 423.505 — Contract provisions
• § 423.506 — Effective date and term of contract
• § 423.507 — Nonrenewal of contract
• § 423.508 — Modification or termination of contract by mutual consent
• § 423.509 — Termination of contract by CMS
• § 423.510 — Termination of contract by the Part D sponsor
• § 423.512 — Minimum enrollment requirements
• § 423.514 — Validation of Part D reporting requirements
• § 423.516 — Prohibition of midyear implementation of significant new regulatory requirements
• § 423.520 — Prompt payment by Part D sponsors
• § 423.521 — Final settlement process and payment
• § 423.522 — Requesting an appeal of the final settlement amount
• § 423.530 — Plan crosswalks
• § 423.551 — General provisions
• § 423.552 — Novation agreement requirements
• § 423.553 — Effect of leasing of a PDP sponsor's facilities
• § 423.558 — Scope
• § 423.560 — Definitions
• § 423.562 — General provisions
• § 423.564 — Grievance procedures
• § 423.566 — Coverage determinations
• § 423.568 — Standard timeframe and notice requirements for coverage determinations
• § 423.570 — Expediting certain coverage determinations
• § 423.572 — Timeframes and notice requirements for expedited coverage determinations
• § 423.576 — Effect of a coverage determination
• § 423.578 — Exceptions process
• § 423.580 — Right to a redetermination
• § 423.582 — Request for a standard redetermination
• § 423.584 — Expediting certain redeterminations
• § 423.586 — Opportunity to submit evidence
• § 423.590 — Timeframes and responsibility for making redeterminations
• § 423.600 — Reconsideration by an independent review entity (IRE)
• § 423.602 — Notice of reconsideration determination by the independent review entity
• § 423.604 — Effect of a reconsideration determination
• § 423.610-423.634 — 423.610-423.634 [Reserved]
• § 423.636 — How a Part D plan sponsor must effectuate standard redeterminations, reconsiderations, or decisions
• § 423.638 — How a Part D plan sponsor must effectuate expedited redeterminations or reconsiderations
• § 423.641 — Contract determinations
• § 423.642 — Notice of contract determination
• § 423.643 — Effect of contract determination
• § 423.650 — Right to a hearing, burden of proof, standard of proof, and standards of review
• § 423.651 — Request for hearing
• § 423.652 — Postponement of effective date of a contract determination when a request for a hearing is filed timely
• § 423.653 — Designation of hearing officer
• § 423.654 — Disqualification of hearing officer
• § 423.655 — Time and place of hearing
• § 423.656 — Appointment of representatives
• § 423.657 — Authority of representatives
• § 423.658 — Conduct of hearing
• § 423.659 — Evidence
• § 423.660 — Witnesses
• § 423.661 — Witnesses lists and documents
• § 423.662 — Prehearing and summary judgment
• § 423.663 — Record of hearing
• § 423.664 — Authority of hearing officer
• § 423.665 — Notice and effect of hearing decision
• § 423.666 — Review by the Administrator
• § 423.667 — Effect of Administrator's decision
• § 423.668 — Reopening of a contract determination or decision of a hearing officer or the Administrator
• § 423.750 — Types of intermediate sanctions and civil money penalties
• § 423.752 — Basis for imposing intermediate sanctions and civil money penalties
• § 423.756 — Procedures for imposing intermediate sanctions and civil money penalties
• § 423.758 — Collection of civil money penalties imposed by CMS
• § 423.760 — Determinations regarding the amount of civil money penalties and assessment imposed by CMS
• § 423.762 — Settlement of penalties
• § 423.764 — Other applicable provisions
• § 423.771 — Basis and scope
• § 423.772 — Definitions
• § 423.773 — Requirements for eligibility
• § 423.774 — Eligibility determinations, redeterminations, and applications
• § 423.780 — Premium subsidy
• § 423.782 — Cost-sharing subsidy
• § 423.800 — Administration of subsidy program
• § 423.851 — Scope
• § 423.855 — Definitions
• § 423.859 — Assuring access to a choice of coverage
• § 423.863 — Submission and approval of bids
• § 423.867 — Rules regarding premiums
• § 423.871 — Contract terms and conditions
• § 423.875 — Payment to fallback plans
• § 423.880 — Basis and scope
• § 423.882 — Definitions
• § 423.884 — Requirements for qualified retiree prescription drug plans
• § 423.886 — Retiree drug subsidy amounts
• § 423.888 — Payment methods, including provision of necessary information
• § 423.890 — Appeals
• § 423.892 — Change of ownership
• § 423.894 — Construction
• § 423.900 — Basis and scope
• § 423.902 — Definitions
• § 423.904 — Eligibility determinations for low-income subsidies
• § 423.906 — General payment provisions
• § 423.907 — Treatment of territories
• § 423.908 — Phased-down State contribution to drug benefit costs assumed by Medicare
• § 423.910 — Requirements
• § 423.1000 — Basis and scope
• § 423.1002 — Definitions
• § 423.1004 — Scope and applicability
• § 423.1006 — Appeal rights
• § 423.1008 — Appointment of representatives
• § 423.1010 — Authority of representatives
• § 423.1012 — Fees for services of representatives
• § 423.1014 — Charge for transcripts
• § 423.1016 — Filing of briefs with the Administrative Law Judge or Departmental Appeals Board, and opportunity for rebuttal
• § 423.1018 — Notice and effect of initial determinations
• § 423.1020 — Request for hearing
• § 423.1022 — Parties to the hearing
• § 423.1024 — Designation of hearing official
• § 423.1026 — Disqualification of Administrative Law Judge
• § 423.1028 — Prehearing conference
• § 423.1030 — Notice of prehearing conference
• § 423.1032 — Conduct of prehearing conference
• § 423.1034 — Record, order, and effect of prehearing conference
• § 423.1036 — Time and place of hearing
• § 423.1038 — Change in time and place of hearing
• § 423.1040 — Joint hearings
• § 423.1042 — Hearing on new issues
• § 423.1044 — Subpoenas
• § 423.1046 — Conduct of hearing
• § 423.1048 — Evidence
• § 423.1050 — Witnesses
• § 423.1052 — Oral and written summation
• § 423.1054 — Record of hearing
• § 423.1056 — Waiver of right to appear and present evidence
• § 423.1058 — Dismissal of request for hearing
• § 423.1060 — Dismissal for abandonment
• § 423.1062 — Dismissal for cause
• § 423.1064 — Notice and effect of dismissal and right to request review
• § 423.1066 — Vacating a dismissal of request for hearing
• § 423.1068 — Administrative Law Judge's decision
• § 423.1070 — Removal of hearing to Departmental Appeals Board
• § 423.1072 — Remand by the Administrative Law Judge
• § 423.1074 — Right to request Departmental Appeals Board review of Administrative Law Judge's decision or dismissal
• § 423.1076 — Request for Departmental Appeals Board review
• § 423.1078 — Departmental Appeals Board action on request for review
• § 423.1080 — Procedures before the Departmental Appeals Board on review
• § 423.1082 — Evidence admissible on review
• § 423.1084 — Decision or remand by the Departmental Appeals Board
• § 423.1086 — Effect of Departmental Appeals Board Decision
• § 423.1088 — Extension of time for seeking judicial review
• § 423.1090 — Basis, timing, and authority for reopening an Administrative Law Judge or Board decision
• § 423.1092 — Revision of reopened decision
• § 423.1094 — Notice and effect of revised decision
• § 423.1968 — Scope
• § 423.1970-423.1976 — 423.1970-423.1976 [Reserved]
• § 423.1978 — Reopening determinations and decisions
• § 423.1980 — Reopening of coverage determinations, redeterminations, reconsiderations, decisions, and reviews
• § 423.1982 — Notice of a revised determination or decision
• § 423.1984 — Effect of a revised determination or decision
• § 423.1986 — Good cause for reopening
• § 423.1990 — Expedited access to judicial review
• § 423.2000 — Hearing before an ALJ and decision by an ALJ or attorney adjudicator: General rule
• § 423.2002 — Right to an ALJ hearing
• § 423.2004 — Right to a review of IRE notice of dismissal
• § 423.2006 — Amount in controversy required for an ALJ hearing and judicial review
• § 423.2008 — Parties to the proceedings on a request for an ALJ hearing
• § 423.2010 — When CMS, the IRE, or Part D plan sponsors may participate in the proceedings on a request for an ALJ hearing
• § 423.2014 — Request for an ALJ hearing or a review of an IRE dismissal
• § 423.2016 — Timeframes for deciding an appeal of an IRE reconsideration
• § 423.2018 — Submitting evidence
• § 423.2020 — Time and place for a hearing before an ALJ
• § 423.2022 — Notice of a hearing before an ALJ
• § 423.2024 — Objections to the issues
• § 423.2026 — Disqualification of the ALJ or attorney adjudicator
• § 423.2030 — ALJ hearing procedures
• § 423.2032 — Issues before an ALJ or attorney adjudicator
• § 423.2034 — Requesting information from the IRE
• § 423.2036 — Description of an ALJ hearing process
• § 423.2038 — Deciding a case without a hearing before an ALJ
• § 423.2040 — Prehearing and posthearing conferences
• § 423.2042 — The administrative record
• § 423.2044 — Consolidated proceedings
• § 423.2046 — Notice of an ALJ or attorney adjudicator decision
• § 423.2048 — The effect of an ALJ's or attorney adjudicator's decision
• § 423.2050 — Removal of a hearing request from OMHA to the Council
• § 423.2052 — Dismissal of a request for a hearing before an ALJ or request for review of an IRE dismissal
• § 423.2054 — Effect of dismissal of a request for a hearing or request for review of an IRE's dismissal
• § 423.2056 — Remands of requests for hearing and requests for review
• § 423.2058 — Effect of a remand
• § 423.2062 — Applicability of policies not binding on the ALJ and Council
• § 423.2063 — Applicability of laws, regulations, CMS Rulings, and precedential decisions
• § 423.2100 — Medicare Appeals Council review: general
• § 423.2102 — Request for Council review when ALJ or attorney adjudicator issues decision or dismissal
• § 423.2106 — Where a request for review may be filed
• § 423.2108 — Council Actions when request for review is filed
• § 423.2110 — Council reviews on its own motion
• § 423.2112 — Content of request for review
• § 423.2114 — Dismissal of request for review
• § 423.2116 — Effect of dismissal of request for Council review or request for hearing
• § 423.2118 — Obtaining evidence from the Council
• § 423.2120 — Filing briefs with the Council
• § 423.2122 — What evidence may be submitted to the Council
• § 423.2124 — Oral argument
• § 423.2126 — Case remanded by the Council
• § 423.2128 — Action of the Council
• § 423.2130 — Effect of the Council's decision
• § 423.2134 — Extension of time to file action in Federal District Court
• § 423.2136 — Judicial review
• § 423.2138 — Case remanded by a Federal District Court
• § 423.2140 — Council Review of ALJ or attorney adjudicator decision in a case remanded by a Federal District Court
• § 423.2260 — Definitions
• § 423.2261 — Submission, review, and distribution of materials
• § 423.2262 — General communications materials and activity requirements
• § 423.2263 — General marketing requirements
• § 423.2264 — Beneficiary contact
• § 423.2265 — Websites
• § 423.2266 — Activities with healthcare providers or in the healthcare setting
• § 423.2267 — Required materials and content
• § 423.2272 — Licensing of marketing representatives and confirmation of marketing resources
• § 423.2274 — Agent, broker, and other third-party requirements
• § 423.2276 — Employer group retiree marketing
• § 423.2300 — Scope
• § 423.2305 — Definitions
• § 423.2310 — Condition for coverage of drugs under Part D
• § 423.2315 — Medicare Coverage Gap Discount Program Agreement
• § 423.2320 — Payment processes for Part D sponsors
• § 423.2325 — Provision of applicable discounts
• § 423.2330 — Manufacturer discount payment audit and dispute resolution
• § 423.2335 — Beneficiary dispute resolution
• § 423.2340 — Compliance monitoring and civil money penalties
• § 423.2345 — Termination of Discount Program Agreement
• § 423.2400 — Basis and scope
• § 423.2401 — Definitions
• § 423.2410 — General requirements
• § 423.2420 — Calculation of medical loss ratio
• § 423.2430 — Activities that improve health care quality
• § 423.2440 — Credibility adjustment
• § 423.2450 — [Reserved]
• § 423.2460 — Reporting requirements
• § 423.2470 — Remittance to CMS if the applicable MLR requirement is not met
• § 423.2480 — MLR review and non-compliance
• § 423.2490 — Release of Part D MLR data
• § 423.2500 — Basis and scope
• § 423.2504 — LI NET eligibility and enrollment
• § 423.2508 — LI NET benefits and beneficiary protections
• § 423.2512 — LI NET sponsor requirements
• § 423.2516 — Selection of LI NET sponsor and contracting provisions
• § 423.2518 — Intermediate sanctions for the LI NET sponsor
• § 423.2520 — Non-renewal or termination of appointment
• § 423.2524 — Bidding and payments to LI NET sponsor
• § 423.2536 — Waiver of Part D program requirements
• § 423.2600 — Payment appeals
• § 423.2605 — Request for reconsideration
• § 423.2610 — Hearing official review
• § 423.2615 — Review by the Administrator

PART 424

• § 424.1 — Basis and scope
• § 424.3 — Definitions
• § 424.5 — Basic conditions
• § 424.7 — General limitations
• § 424.10 — Purpose and scope
• § 424.11 — General procedures
• § 424.13 — Requirements for inpatient services of hospitals other than inpatient psychiatric facilities
• § 424.14 — Requirements for inpatient services of inpatient psychiatric facilities
• § 424.15 — Requirements for inpatient CAH services
• § 424.16 — Timing of certification for individual admitted to a hospital before entitlement to Medicare benefits
• § 424.20 — Requirements for posthospital SNF care
• § 424.22 — Requirements for home health services
• § 424.24 — Requirements for medical and other health services furnished by providers under Medicare Part B
• § 424.27 — Requirements for comprehensive outpatient rehabilitation facility (CORF) services
• § 424.30 — Scope
• § 424.32 — Basic requirements for all claims
• § 424.33 — Additional requirements: Claims for services of providers and claims by suppliers and nonparticipating hospitals
• § 424.34 — Additional requirements: Beneficiary's claim for direct payment
• § 424.36 — Signature requirements
• § 424.37 — Evidence of authority to sign on behalf of the beneficiary
• § 424.40 — Request for payment effective for more than one claim
• § 424.44 — Time limits for filing claims
• § 424.50 — Scope
• § 424.51 — Payment to the provider
• § 424.52 — Payment to a nonparticipating hospital
• § 424.53 — Payment to the beneficiary
• § 424.54 — Payment to the beneficiary's legal guardian or representative payee
• § 424.55 — Payment to the supplier
• § 424.56 — Payment to a beneficiary and to a supplier
• § 424.57 — Special payment rules for items furnished by DMEPOS suppliers and issuance of DMEPOS supplier billing privileges
• § 424.58 — Accreditation
• § 424.60 — Scope
• § 424.62 — Payment after beneficiary's death: Bill has been paid
• § 424.64 — Payment after beneficiary's death: Bill has not been paid
• § 424.66 — Payment to entities that provide coverage complementary to Medicare Part B
• § 424.67 — Enrollment requirements for opioid treatment programs (OTP)
• § 424.68 — Enrollment requirements for home infusion therapy suppliers
• § 424.70 — Basis and scope
• § 424.71 — Definitions
• § 424.73 — Prohibition of assignment of claims by providers
• § 424.74 — Termination of provider agreement
• § 424.80 — Prohibition of reassignment of claims by suppliers
• § 424.82 — Revocation of right to receive assigned benefits
• § 424.83 — Hearings on revocation of right to receive assigned benefits
• § 424.84 — Final determination on revocation of right to receive assigned benefits
• § 424.86 — Prohibition of assignment of claims by beneficiaries
• § 424.90 — Court ordered assignments: Conditions and limitations
• § 424.100 — Scope
• § 424.101 — Definitions
• § 424.102 — Situations that do not constitute an emergency
• § 424.103 — Conditions for payment for emergency services
• § 424.104 — Election to claim payment for emergency services furnished during a calendar year
• § 424.106 — Criteria for determining whether the hospital was the most accessible
• § 424.108 — Payment to a hospital
• § 424.109 — Payment to the beneficiary
• § 424.120 — Scope
• § 424.121 — Scope of payments
• § 424.122 — Conditions for payment for emergency inpatient hospital services
• § 424.123 — Conditions for payment for nonemergency inpatient services furnished by a hospital closer to the individual's residence
• § 424.124 — Conditions for payment for physician services and ambulance services
• § 424.126 — Payment to the hospital
• § 424.127 — Payment to the beneficiary
• § 424.200 — Scope
• § 424.205 — Requirements for Medicare Diabetes Prevention Program suppliers
• § 424.210 — Beneficiary engagement incentives under the Medicare Diabetes Prevention Program expanded model
• § 424.350 — Replacement of checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements
• § 424.352 — Intermediary and carrier checks that are lost, stolen, defaced, mutilated, destroyed or paid on forged endorsements
• § 424.500 — Scope
• § 424.502 — Definitions
• § 424.505 — Basic enrollment requirement
• § 424.506 — National Provider Identifier (NPI) on all enrollment applications and claims
• § 424.507 — Ordering covered items and services for Medicare beneficiaries
• § 424.510 — Requirements for enrolling in the Medicare program
• § 424.514 — Application fee
• § 424.515 — Requirements for reporting changes and updates to, and the periodic revalidation of Medicare enrollment information
• § 424.516 — Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program
• § 424.517 — Onsite review
• § 424.518 — Screening levels for Medicare providers and suppliers
• § 424.519 — Disclosure of affiliations
• § 424.520 — Effective date of Medicare billing privileges
• § 424.521 — Request for payment by certain provider and supplier types
• § 424.522 — Additional effective dates
• § 424.525 — Rejection of a provider's or supplier's application for Medicare enrollment
• § 424.526 — Return of a provider's or supplier's enrollment application
• § 424.527 — Provisional period of enhanced oversight
• § 424.530 — Denial of enrollment in the Medicare program
• § 424.535 — Revocation of enrollment in the Medicare program
• § 424.540 — Deactivation of Medicare billing privileges
• § 424.541 — Stay of enrollment
• § 424.542 — Prohibition on ordering, certifying, referring, or prescribing based on felony conviction
• § 424.545 — Provider and supplier appeal rights
• § 424.546 — Deactivation rebuttals
• § 424.547 — Deactivation based on ordering, certifying, or referring services and items
• § 424.550 — Prohibitions on the sale or transfer of billing privileges
• § 424.551 — DMEPOS supplier changes in majority ownership
• § 424.555 — Payment liability
• § 424.565 — Overpayment
• § 424.570 — Moratoria on newly enrolling Medicare providers and suppliers
• § 424.575 — Rural emergency hospitals

PART 425

• § 425.10 — Basis and scope
• § 425.20 — Definitions
• § 425.100 — General
• § 425.102 — Eligible providers and suppliers
• § 425.104 — Legal entity
• § 425.106 — Shared governance
• § 425.108 — Leadership and management
• § 425.110 — Number of ACO professionals and beneficiaries
• § 425.112 — Required processes and patient-centeredness criteria
• § 425.114 — Participation in other shared savings initiatives
• § 425.116 — Agreements with ACO participants and ACO providers/suppliers
• § 425.118 — Required reporting of ACO participants and ACO providers/suppliers
• § 425.200 — Participation agreement with CMS
• § 425.202 — Application procedures
• § 425.204 — Content of the application
• § 425.206 — Evaluation procedures for applications
• § 425.208 — Provisions of participation agreement
• § 425.210 — Application of agreement to ACO participants, ACO providers/suppliers, and others
• § 425.212 — Changes to program requirements during the agreement period
• § 425.214 — Managing changes to the ACO during the agreement period
• § 425.216 — Actions prior to termination
• § 425.218 — Termination of the participation agreement by CMS
• § 425.220 — Termination of the participation agreement by the ACO
• § 425.221 — Close-out procedures and payment consequences of early termination
• § 425.222 — Eligibility to re-enter the program for agreement periods beginning before July 1, 2019
• § 425.224 — Application procedures for renewing ACOs and re-entering ACOs
• § 425.226 — Annual participation elections
• § 425.300 — Compliance plan
• § 425.302 — Program requirements for data submission and certifications
• § 425.304 — Beneficiary incentives
• § 425.305 — Other program safeguards
• § 425.306 — Participant agreement and exclusivity of ACO participants
• § 425.308 — Public reporting and transparency
• § 425.310 — Marketing requirements
• § 425.312 — Beneficiary notifications
• § 425.314 — Audits and record retention
• § 425.315 — Reopening determinations of ACO shared savings or shared losses to correct financial reconciliation calculations
• § 425.316 — Monitoring of ACOs
• § 425.400 — General
• § 425.401 — Criteria for a beneficiary to be assigned to an ACO
• § 425.402 — Basic assignment methodology
• § 425.404 — Special assignment conditions for ACOs including FQHCs and RHCs
• § 425.500 — Measures to assess the quality of care furnished by an ACO for performance years (or a performance period) beginning on or before January 1, 2020
• § 425.502 — Calculating the ACO quality performance score for performance years (or a performance period) beginning on or before January 1, 2020
• § 425.504 — Incorporating reporting requirements related to the Physician Quality Reporting System Incentive and Payment Adjustment
• § 425.506 — Incorporating reporting requirements related to adoption of certified electronic health record technology
• § 425.507 — Incorporating Promoting Interoperability requirements related to the Quality Payment Program for performance years beginning on or after January 1, 2025
• § 425.508 — Incorporating quality reporting requirements related to the Quality Payment Program
• § 425.510 — Application of the APM Performance Pathway (APP) quality measure set or the APP Plus quality measure set (as applicable) to Shared Savings Program ACOs for performance years beginning on or after January 1, 2021
• § 425.512 — Determining the ACO quality performance standard for performance years beginning on or after January 1, 2021
• § 425.600 — Selection of risk model
• § 425.601 — Establishing, adjusting, and updating the benchmark for agreement periods beginning on or after July 1, 2019, and before January 1, 2024
• § 425.602 — Establishing, adjusting, and updating the benchmark for an ACO's first agreement period beginning on or before January 1, 2018
• § 425.603 — Resetting, adjusting, and updating the benchmark for a subsequent agreement period beginning on or before January 1, 2019
• § 425.604 — Calculation of savings under the one-sided model
• § 425.605 — Calculation of shared savings and losses under the BASIC track
• § 425.606 — Calculation of shared savings and losses under Track 2
• § 425.608 — Determining first year performance for ACOs beginning April 1 or July 1, 2012
• § 425.609 — Determining performance for 6-month performance years during CY 2019
• § 425.610 — Calculation of shared savings and losses under the ENHANCED track
• § 425.611 — Adjustments to Shared Savings Program calculations to address the COVID-19 pandemic
• § 425.612 — Waivers of payment rules or other Medicare requirements
• § 425.613 — Telehealth services
• § 425.614-425.629 — 425.614-425.629 [Reserved]
• § 425.630 — Option to receive advance investment payments
• § 425.631-425.639 — 425.631-425.639 [Reserved]
• § 425.640 — Option to receive prepaid shared savings
• § 425.641-425.649 — 425.641-425.649 [Reserved]
• § 425.650 — Benchmarking methodology
• § 425.652 — Establishing, adjusting, and updating the benchmark for agreement periods beginning on January 1, 2024, and in subsequent years
• § 425.654 — Calculating county expenditures and regional expenditures
• § 425.655 — Calculating the regional risk score growth cap adjustment factor
• § 425.656 — Calculating the regional adjustment to the historical benchmark
• § 425.658 — Calculating the prior savings adjustment to the historical benchmark
• § 425.659 — Calculating risk scores used in Shared Savings Program benchmark calculations
• § 425.660 — Accountable Care Prospective Trend (ACPT)
• § 425.661 — [Reserved]
• § 425.662 — Calculating the population adjustment to the historical benchmark
• § 425.663-425.669 — [Reserved]
• § 425.670 — Adjustments to mitigate the impact of significant, anomalous, and highly suspect billing activity on Shared Savings Program financial calculations involving calendar year 2023
• § 425.672 — Adjustments to mitigate the impact of significant, anomalous, and highly suspect billing activity on Shared Savings Program financial calculations involving calendar year 2024 or subsequent calendar years
• § 425.674 — Accounting for the impact of improper payments on Shared Savings Program financial calculations
• § 425.700 — General rules
• § 425.702 — Aggregate reports
• § 425.704 — Beneficiary-identifiable claims data
• § 425.706 — Minimum necessary data
• § 425.708 — Beneficiaries may decline claims data sharing
• § 425.710 — Data use agreement
• § 425.800 — Preclusion of administrative and judicial review
• § 425.802 — Request for review
• § 425.804 — Reconsideration review process
• § 425.806 — On-the-record review of reconsideration official's recommendation by independent CMS official
• § 425.808 — Effect of independent CMS official's decision
• § 425.810 — Effective date of decision

PART 426

• § 426.100 — Basis and scope
• § 426.110 — Definitions
• § 426.120 — Calculation of deadlines
• § 426.130 — Party submissions
• § 426.300 — Review of LCDs, NCDs, and deemed NCDs
• § 426.310 — LCD and NCD reviews and individual claim appeals
• § 426.320 — Who may challenge an LCD or NCD
• § 426.325 — What may be challenged
• § 426.330 — Burden of proof
• § 426.340 — Procedures for review of new evidence
• § 426.400 — Procedure for filing an acceptable complaint concerning a provision (or provisions) of an LCD
• § 426.403 — Submitting new evidence once an acceptable complaint is filed
• § 426.405 — Authority of the ALJ
• § 426.406 — Ex parte contacts
• § 426.410 — Docketing and evaluating the acceptability of LCD complaints
• § 426.415 — CMS' role in the LCD review
• § 426.416 — Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review
• § 426.417 — Contractor's statement regarding new evidence
• § 426.418 — LCD record furnished to aggrieved party
• § 426.419 — LCD record furnished to the ALJ
• § 426.420 — Retiring or revising an LCD under review
• § 426.423 — Withdrawing a complaint regarding an LCD under review
• § 426.425 — LCD review
• § 426.431 — ALJ's review of the LCD to apply the reasonableness standard
• § 426.432 — Discovery
• § 426.435 — Subpoenas
• § 426.440 — Evidence
• § 426.444 — Dismissals for cause
• § 426.445 — Witness fees
• § 426.446 — Record of hearing
• § 426.447 — Issuance and notification of an ALJ's decision
• § 426.450 — Mandatory provisions of an ALJ's decision
• § 426.455 — Prohibited provisions of an ALJ's decision
• § 426.457 — Optional provisions of an ALJ's decision
• § 426.458 — ALJ's LCD review record
• § 426.460 — Effect of an ALJ's decision
• § 426.462 — Notice of an ALJ's decision
• § 426.463 — Future new or revised LCDs
• § 426.465 — Appealing part or all of an ALJ's decision
• § 426.468 — Decision to not appeal an ALJ's decision
• § 426.470 — Board's role in docketing and evaluating the acceptability of appeals of ALJ decisions
• § 426.476 — Board review of an ALJ's decision
• § 426.478 — Retiring or revising an LCD during the Board's review of an ALJ's decision
• § 426.480 — Withdrawing an appeal of an ALJ's decision
• § 426.482 — Issuance and notification of a Board decision
• § 426.484 — Mandatory provisions of a Board decision
• § 426.486 — Prohibited provisions of a Board decision
• § 426.487 — Board's record on appeal of an ALJ's decision
• § 426.488 — Effect of a Board decision
• § 426.489 — Board remands
• § 426.490 — Board decision
• § 426.500 — Procedure for filing an acceptable complaint concerning a provision (or provisions) of an NCD
• § 426.503 — Submitting new evidence once an acceptable complaint has been filed
• § 426.505 — Authority of the Board
• § 426.506 — Ex parte contacts
• § 426.510 — Docketing and evaluating the acceptability of NCD complaints
• § 426.513 — Participation as amicus curiae
• § 426.515 — CMS' role in making the NCD record available
• § 426.516 — Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process
• § 426.517 — CMS' statement regarding new evidence
• § 426.518 — NCD record furnished to the aggrieved party
• § 426.519 — NCD record furnished to the Board
• § 426.520 — Withdrawing an NCD under review or issuing a revised or reconsidered NCD
• § 426.523 — Withdrawing a complaint regarding an NCD under review
• § 426.525 — NCD review
• § 426.531 — Board's review of the NCD to apply the reasonableness standard
• § 426.532 — Discovery
• § 426.535 — Subpoenas
• § 426.540 — Evidence
• § 426.544 — Dismissals for cause
• § 426.545 — Witness fees
• § 426.546 — Record of hearing
• § 426.547 — Issuance, notification, and posting of a Board's decision
• § 426.550 — Mandatory provisions of the Board's decision
• § 426.555 — Prohibited provisions of the Board's decision
• § 426.557 — Optional provisions of the Board's decision
• § 426.560 — Effect of the Board's decision
• § 426.562 — Notice of the Board's decision
• § 426.563 — Future new or revised or reconsidered NCDs
• § 426.565 — Board's role in making an LCD or NCD review record available
• § 426.566 — Board decision
• § 426.587 — Record for appeal of a Board NCD decision

PART 427

• § 427.10 — Basis and scope
• § 427.20 — Definitions
• § 427.100 — Definitions
• § 427.101 — Identification of Part B rebatable drugs
• § 427.200 — Definitions
• § 427.201 — Computation of beneficiary coinsurance and adjusted Medicare payment for Part B rebatable drugs with price increases faster than inflation
• § 427.300 — Definitions
• § 427.301 — Calculation of the total Part B rebate amount to be paid by manufacturers
• § 427.302 — Calculation of the per unit Part B rebate
• § 427.303 — Determination of total number of billing units
• § 427.304 — Adjustments for changes to billing and payment codes
• § 427.400 — Definitions
• § 427.401 — Reducing the rebate amount for Part B rebatable drugs currently in shortage
• § 427.402 — Reducing the rebate amount for certain Part B rebatable drugs when there is a severe supply chain disruption
• § 427.500 — Definitions
• § 427.501 — Rebate Reports and reconciliation
• § 427.502 — Rebate Reports for applicable calendar quarters in calendar years 2023 and 2024
• § 427.503 — Suggestion of Error
• § 427.504 — Manufacturer access to Rebate Reports
• § 427.505 — Deadline and process for payment of rebate amount
• § 427.600 — Civil money penalty notice and appeals procedures

PART 428

• § 428.10 — Basis and scope
• § 428.20 — Definitions
• § 428.100 — Definitions
• § 428.101 — Identification of Part D rebatable drugs
• § 428.200 — Definitions
• § 428.201 — Calculation of the total rebate amount to be paid by manufacturers
• § 428.202 — Calculation of the per unit Part D rebate amount
• § 428.203 — Determination of the total number of units dispensed under Part D
• § 428.204 — Treatment of new formulations of Part D rebatable drugs
• § 428.300 — Definitions
• § 428.301 — Reducing the rebate amount for Part D rebatable drugs currently in shortage
• § 428.302 — Reducing the rebate amount for certain Part D rebatable drugs when there is a severe supply chain disruption
• § 428.303 — Reducing the rebate amount for generic Part D rebatable drugs likely to be in shortage
• § 428.400 — Definitions
• § 428.401 — Rebate Reports and reconciliation
• § 428.402 — Rebate Reports for applicable periods beginning October 1, 2022, and October 1, 2023
• § 428.403 — Suggestion of Error
• § 428.404 — Manufacturer access to Rebate Reports
• § 428.405 — Deadline and process for payment of rebate amount
• § 428.500 — Civil money penalty notice and appeals procedures

PART 430

• § 430.0 — Program description
• § 430.1 — Scope of subchapter C
• § 430.2 — Other applicable Federal regulations
• § 430.3 — Appeals under Medicaid
• § 430.5 — Definitions
• § 430.10 — The State plan
• § 430.12 — Submittal of State plans and plan amendments
• § 430.14 — Review of State plan material
• § 430.15 — Basis and authority for action on State plan material
• § 430.16 — Timing and notice of action on State plan material
• § 430.18 — Administrative review of action on State plan material
• § 430.20 — Effective dates of State plans and plan amendments
• § 430.25 — Waivers of State plan requirements
• § 430.30 — Grants procedures
• § 430.32 — Program reviews
• § 430.33 — Audits
• § 430.35 — Withholding of payment for failure to comply with Federal requirements
• § 430.38 — Judicial review
• § 430.40 — Deferral of claims for FFP
• § 430.42 — Disallowance of claims for FFP
• § 430.45 — Reduction of Federal Medicaid payments
• § 430.48 — Repayment of Federal funds by installments
• § 430.49 — Corrective action plans, suspensions of procedural disenrollments, and civil money penalties
• § 430.60 — Scope
• § 430.62 — Records to be public
• § 430.63 — Filing and service of papers
• § 430.64 — Suspension of rules
• § 430.66 — Designation of presiding officer for hearing
• § 430.70 — Notice of hearing or opportunity for hearing
• § 430.72 — Time and place of hearing
• § 430.74 — Issues at hearing
• § 430.76 — Parties to the hearing
• § 430.80 — Authority of the presiding officer
• § 430.83 — Rights of parties
• § 430.86 — Discovery
• § 430.88 — Evidence
• § 430.90 — Exclusion from hearing for misconduct
• § 430.92 — Unsponsored written material
• § 430.94 — Official transcript
• § 430.96 — Record for decision
• § 430.100 — Posthearing briefs
• § 430.102 — Decisions following hearing
• § 430.104 — Decisions that affect FFP

PART 431

• § 431.1 — Purpose
• § 431.10 — Single State agency
• § 431.11 — Organization for administration
• § 431.12 — Medicaid Advisory Committee and Beneficiary Advisory Council
• § 431.15 — Methods of administration
• § 431.16 — Reports
• § 431.17 — Maintenance of records
• § 431.18 — Availability of agency program manuals
• § 431.20 — Advance directives
• § 431.40 — Basis and scope
• § 431.50 — Statewide operation
• § 431.51 — Free choice of providers
• § 431.52 — Payments for services furnished out of State
• § 431.53 — Assurance of transportation
• § 431.54 — Exceptions to certain State plan requirements
• § 431.55 — Waiver of other Medicaid requirements
• § 431.56 — Special waiver provisions applicable to American Samoa and the Northern Mariana Islands
• § 431.60 — Beneficiary access to and exchange of data
• § 431.61 — Access to and exchange of health data for providers and payers
• § 431.70 — Access to published provider directory information
• § 431.80 — Prior authorization requirements
• § 431.105 — Consultation to medical facilities
• § 431.107 — Required provider agreement
• § 431.108 — Effective date of provider agreements
• § 431.110 — Participation by Indian Health Service facilities
• § 431.115 — Disclosure of survey information and provider or contractor evaluation
• § 431.120 — State requirements with respect to nursing facilities
• § 431.151 — Scope and applicability
• § 431.152 — State plan requirements
• § 431.153 — Evidentiary hearing
• § 431.154 — Informal reconsideration for ICFs/IID
• § 431.200 — Basis and scope
• § 431.201 — Definitions
• § 431.202 — State plan requirements
• § 431.205 — Provision of hearing system
• § 431.206 — Informing applicants and beneficiaries
• § 431.210 — Content of notice
• § 431.211 — Advance notice
• § 431.213 — Exceptions from advance notice
• § 431.214 — Notice in cases of probable fraud
• § 431.220 — When a hearing is required
• § 431.221 — Request for hearing
• § 431.222 — Group hearings
• § 431.223 — Denial or dismissal of request for a hearing
• § 431.224 — Expedited appeals
• § 431.230 — Maintaining services
• § 431.231 — Reinstating services
• § 431.232 — Adverse decision of local evidentiary hearing
• § 431.233 — State agency hearing after adverse decision of local evidentiary hearing
• § 431.240 — Conducting the hearing
• § 431.241 — Matters to be considered at the hearing
• § 431.242 — Procedural rights of the applicant or beneficiary
• § 431.243 — Parties in cases involving an eligibility determination
• § 431.244 — Hearing decisions
• § 431.245 — Notifying the applicant or beneficiary of a State agency decision
• § 431.246 — Corrective action
• § 431.250 — Federal financial participation
• § 431.300 — Basis and purpose
• § 431.301 — State plan requirements
• § 431.302 — Purposes directly related to State plan administration
• § 431.303 — State authority for safeguarding information
• § 431.304 — Publicizing safeguarding requirements
• § 431.305 — Types of information to be safeguarded
• § 431.306 — Release of information
• § 431.307 — Distribution of information materials
• § 431.400 — Basis and purpose
• § 431.404 — Definitions
• § 431.408 — State public notice process
• § 431.412 — Application procedures
• § 431.416 — Federal public notice and approval process
• § 431.420 — Monitoring and compliance
• § 431.424 — Evaluation requirements
• § 431.428 — Reporting requirements
• § 431.610 — Relations with standard-setting and survey agencies
• § 431.615 — Relations with State health and vocational rehabilitation agencies and title V grantees
• § 431.620 — Agreement with State mental health authority or mental institutions
• § 431.621 — State requirements with respect to nursing facilities
• § 431.625 — Coordination of Medicaid with Medicare part B
• § 431.630 — Coordination of Medicaid with QIOs
• § 431.635 — Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children (WIC)
• § 431.700 — Basis and purpose
• § 431.701 — Definitions
• § 431.702 — State plan requirement
• § 431.703 — Licensing requirement
• § 431.704 — Nursing homes designated by other terms
• § 431.705 — Licensing authority
• § 431.706 — Composition of licensing board
• § 431.707 — Standards
• § 431.708 — Procedures for applying standards
• § 431.709 — Issuance and revocation of license
• § 431.710 — Provisional licenses
• § 431.711 — Compliance with standards
• § 431.712 — Failure to comply with standards
• § 431.713 — Continuing study and investigation
• § 431.714 — Waivers
• § 431.715 — Federal financial participation
• § 431.800 — Basis and scope
• § 431.804 — Definitions
• § 431.806 — State requirements
• § 431.808 — Protection of beneficiary rights
• § 431.810 — Basic elements of the Medicaid Eligibility Quality Control (MEQC) Program
• § 431.812 — Review procedures
• § 431.814 — Pilot planning document
• § 431.816 — Case review completion deadlines and submittal of reports
• § 431.818 — Access to records
• § 431.820 — Corrective action under the MEQC program
• § 431.830 — Basic elements of the Medicaid quality control (MQC) claims processing assessment system
• § 431.832 — Reporting requirements for claims processing assessment systems
• § 431.834 — Access to records: Claims processing assessment systems
• § 431.836 — Corrective action under the MQC claims processing assessment system
• § 431.950 — Purpose
• § 431.954 — Basis and scope
• § 431.958 — Definitions and use of terms
• § 431.960 — Types of payment errors
• § 431.970 — Information submission and systems access requirements
• § 431.972 — Claims sampling procedures
• § 431.992 — Corrective action plan
• § 431.998 — Difference resolution and appeal process
• § 431.1002 — Recoveries
• § 431.1010 — Disallowance of Federal financial participation for erroneous State payments (for PERM review years ending after July 1, 2020)

PART 432

• § 432.1 — Basis and purpose
• § 432.2 — Definitions
• § 432.10 — Standards of personnel administration
• § 432.30 — Training programs: General requirements
• § 432.31 — Training and use of subprofessional staff
• § 432.32 — Training and use of volunteers
• § 432.45 — Applicability of provisions in subpart
• § 432.50 — FFP: Staffing and training costs
• § 432.55 — Reporting training and administrative costs

PART 433

• § 433.1 — Purpose
• § 433.8 — [Reserved]
• § 433.10 — Rates of FFP for program services
• § 433.11 — Enhanced FMAP rate for children
• § 433.15 — Rates of FFP for administration
• § 433.32 — Fiscal policies and accountability
• § 433.34 — Cost allocation
• § 433.35 — Equipment—Federal financial participation
• § 433.36 — Liens and recoveries
• § 433.37 — Reporting provider payments to Internal Revenue Service
• § 433.38 — Interest charge on disallowed claims for FFP
• § 433.40 — Treatment of uncashed or cancelled (voided) Medicaid checks
• § 433.50 — Basis, scope, and applicability
• § 433.51 — Public Funds as the State share of financial participation
• § 433.52 — General definitions
• § 433.53 — State plan requirements
• § 433.54 — Bona fide donations
• § 433.55 — Health care-related taxes defined
• § 433.56 — Classes of health care services and providers defined
• § 433.57 — General rules regarding revenues from provider-related donations and health care-related taxes
• § 433.58-433.60 — 433.58-433.60 [Reserved]
• § 433.66 — Permissible provider-related donations
• § 433.67 — Limitations on level of FFP for permissible provider-related donations
• § 433.68 — Permissible health care-related taxes
• § 433.70 — Limitation on level of FFP for revenues from health care-related taxes
• § 433.72 — Waiver provisions applicable to health care-related taxes
• § 433.74 — Reporting requirements
• § 433.110 — Basis, purpose, and applicability
• § 433.111 — Definitions
• § 433.112 — FFP for design, development, installation or enhancement of mechanized processing and information retrieval systems
• § 433.114 — Procedures for obtaining initial approval; notice of decision
• § 433.116 — FFP for operation of mechanized claims processing and information retrieval systems
• § 433.117 — Initial approval of replacement systems
• § 433.119 — Conditions for reapproval; notice of decision
• § 433.120 — Procedures for reduction of FFP after reapproval review
• § 433.121 — Reconsideration of the decision to reduce FFP after reapproval review
• § 433.122 — Reapproval of a disapproved system
• § 433.123 — Notification of changes in system requirements, performance standards or other conditions for approval or reapproval
• § 433.127 — Termination of FFP for failure to provide access to claims processing and information retrieval systems
• § 433.131 — Waiver for noncompliance with conditions of approval and reapproval
• § 433.135 — Basis and purpose
• § 433.136 — Definitions
• § 433.137 — State plan requirements
• § 433.138 — Identifying liable third parties
• § 433.139 — Payment of claims
• § 433.140 — FFP and repayment of Federal share
• § 433.145 — Assignment of rights to benefits—State plan requirements
• § 433.146 — Rights assigned; assignment method
• § 433.147 — Cooperation in establishing the identity of a child's parents and in obtaining medical support and payments and in identifying and providing information to assist in pursuing third parties who may be liable to pay
• § 433.148 — Denial or termination of eligibility
• § 433.151 — Cooperative agreements and incentive payments—State plan requirements
• § 433.152 — Requirements for cooperative agreements for third party collections
• § 433.153 — Incentive payments to States and political subdivisions
• § 433.154 — Distribution of collections
• § 433.202 — Scope
• § 433.204 — Definitions
• § 433.206 — Threshold methodology
• § 433.300 — Basis
• § 433.302 — Scope of subpart
• § 433.304 — Definitions
• § 433.310 — Applicability of requirements
• § 433.312 — Basic requirements for refunds
• § 433.316 — When discovery of overpayment occurs and its significance
• § 433.318 — Overpayments involving providers who are bankrupt or out of business
• § 433.320 — Procedures for refunds to CMS
• § 433.322 — Maintenance of Records
• § 433.400 — Continued enrollment for temporary FMAP increase

PART 434

• § 434.1 — Basis and scope
• § 434.2 — Definitions
• § 434.4 — State plan requirement
• § 434.6 — General requirements for all contracts and subcontracts
• § 434.10 — Contracts with fiscal agents
• § 434.12 — Contracts with private nonmedical institutions
• § 434.14 — [Reserved]
• § 434.40 — Contract requirements
• § 434.70 — Conditions for Federal Financial Participation (FFP)
• § 434.76 — Costs under fiscal agent contracts
• § 434.78 — Right to reconsideration of disallowance

PART 435

• § 435.2 — Purpose and applicability
• § 435.3 — Basis
• § 435.4 — Definitions and use of terms
• § 435.10 — State plan requirements
• § 435.100 — Scope
• § 435.110 — Parents and other caretaker relatives
• § 435.112 — Families terminated from AFDC because of increased earnings or hours of employment
• § 435.115 — Families with Medicaid eligibility extended because of increased collection of spousal support
• § 435.116 — Pregnant women
• § 435.117 — Deemed newborn children
• § 435.118 — Infants and children under age 19
• § 435.119 — Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL
• § 435.120 — Individuals receiving SSI
• § 435.121 — Individuals in States using more restrictive requirements for Medicaid than the SSI requirements
• § 435.122 — Individuals who are ineligible for SSI or optional State supplements because of requirements that do not apply under title XIX of the Act
• § 435.123 — Individuals eligible as qualified Medicare beneficiaries
• § 435.124 — Individuals eligible as specified low-income Medicare beneficiaries
• § 435.125 — Individuals eligible as qualifying individuals
• § 435.126 — Individuals eligible as qualified disabled and working individuals
• § 435.130 — Individuals receiving mandatory State supplements
• § 435.131 — Individuals eligible as essential spouses in December 1973
• § 435.132 — Institutionalized individuals who were eligible in December 1973
• § 435.133 — Blind and disabled individuals eligible in December 1973
• § 435.134 — Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336 (July 1, 1972)
• § 435.135 — Individuals who become ineligible for cash assistance as a result of OASDI cost-of-living increases received after April 1977
• § 435.136 — State agency implementation requirements for one-time notice and annual review system
• § 435.137 — Disabled widows and widowers who would be eligible for SSI except for the increase in disability benefits resulting from elimination of the reduction factor under Pub. L. 98-21
• § 435.138 — Disabled widows and widowers aged 60 through 64 who would be eligible for SSI except for early receipt of social security benefits
• § 435.139 — Coverage for certain aliens
• § 435.145 — Children with adoption assistance, foster care, or guardianship care under title IV-E
• § 435.150 — Former foster care children
• § 435.170 — Pregnant women eligible for extended or continuous eligibility
• § 435.172 — Continuous eligibility for hospitalized children
• § 435.200 — Scope
• § 435.201 — Individuals included in optional groups
• § 435.210 — Optional eligibility for individuals who meet the income and resource requirements of the cash assistance programs
• § 435.211 — Optional eligibility for individuals who would be eligible for cash assistance if they were not in medical institutions
• § 435.212 — Individuals who would be ineligible if they were not enrolled in an MCO or PCCM
• § 435.213 — Optional eligibility for individuals needing treatment for breast or cervical cancer
• § 435.214 — Eligibility for Medicaid limited to family planning and related services
• § 435.215 — Individuals infected with tuberculosis
• § 435.217 — Individuals receiving home and community-based services
• § 435.218 — Individuals with MAGI-based income above 133 percent FPL
• § 435.219 — Individuals receiving State plan home and community-based services
• § 435.220 — Optional eligibility for parents and other caretaker relatives
• § 435.221 — [Reserved]
• § 435.222 — Optional eligibility for reasonable classifications of individuals under age 21 with income below a MAGI-equivalent standard in specified eligibility categories
• § 435.223 — Other optional eligibility for reasonable classifications of individuals under age 21
• § 435.225 — Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution
• § 435.226 — Optional eligibility for independent foster care adolescents
• § 435.227 — Optional eligibility for individuals under age 21 who are under State adoption assistance agreements
• § 435.229 — Optional targeted low-income children
• § 435.230 — Aged, blind, and disabled individuals in States that use more restrictive requirements for Medicaid than SSI requirements: Optional coverage
• § 435.232 — Individuals receiving only optional State supplements
• § 435.234 — Individuals receiving only optional State supplements in States using more restrictive eligibility requirements than SSI and certain States using SSI criteria
• § 435.236 — Individuals in institutions who are eligible under a special income level
• § 435.300 — Scope
• § 435.301 — General rules
• § 435.308 — Medically needy coverage of individuals under age 21
• § 435.310 — Medically needy coverage of parents and other caretaker relatives
• § 435.320 — Medically needy coverage of the aged in States that cover individuals receiving SSI
• § 435.322 — Medically needy coverage of the blind in States that cover individuals receiving SSI
• § 435.324 — Medically needy coverage of the disabled in States that cover individuals receiving SSI
• § 435.326 — Individuals who would be ineligible if they were not enrolled in an MCO or PCCM
• § 435.330 — Medically needy coverage of the aged, blind, and disabled in States using more restrictive eligibility requirements for Medicaid than those used under SSI
• § 435.340 — Protected medically needy coverage for blind and disabled individuals eligible in December 1973
• § 435.350 — Coverage for certain aliens
• § 435.400 — Scope
• § 435.401 — General rules
• § 435.402 — [Reserved]
• § 435.403 — State residence
• § 435.404 — Applicant's choice of category
• § 435.406 — Citizenship and noncitizen eligibility
• § 435.407 — Types of acceptable documentary evidence of citizenship
• § 435.500 — Scope
• § 435.520 — Age requirements for the aged
• § 435.530 — Definition of blindness
• § 435.531 — Determinations of blindness
• § 435.540 — Definition of disability
• § 435.541 — Determinations of disability
• § 435.600 — Scope
• § 435.601 — Application of financial eligibility methodologies
• § 435.602 — Financial responsibility of relatives and other individuals
• § 435.603 — Application of modified adjusted gross income (MAGI)
• § 435.604 — [Reserved]
• § 435.606 — [Reserved]
• § 435.608 — [Reserved]
• § 435.610 — Assignment of rights to benefits
• § 435.622 — Individuals in institutions who are eligible under a special income level
• § 435.631 — General requirements for determining income eligibility in States using more restrictive requirements for Medicaid than SSI
• § 435.640 — Protected Medicaid eligibility for individuals eligible in December 1973
• § 435.700 — Scope
• § 435.725 — Post-eligibility treatment of income of institutionalized individuals in SSI States: Application of patient income to the cost of care
• § 435.726 — Post-eligibility treatment of income of individuals receiving home and community-based services furnished under a waiver: Application of patient income to the cost of care
• § 435.733 — Post-eligibility treatment of income of institutionalized individuals in States using more restrictive requirements than SSI: Application of patient income to the cost of care
• § 435.735 — Post-eligibility treatment of income and resources of individuals receiving home and community-based services furnished under a waiver: Application of patient income to the cost of care
• § 435.800 — Scope
• § 435.811 — Medically needy income standard: General requirements
• § 435.814 — Medically needy income standard: State plan requirements
• § 435.831 — Income eligibility
• § 435.832 — Post-eligibility treatment of income of institutionalized individuals: Application of patient income to the cost of care
• § 435.840 — Medically needy resource standard: General requirements
• § 435.843 — Medically needy resource standard: State plan requirements
• § 435.845 — Medically needy resource eligibility
• § 435.850-435.852 — 435.850-435.852 [Reserved]
• § 435.900 — Scope
• § 435.901 — Consistency with objectives and statutes
• § 435.902 — Simplicity of administration
• § 435.903 — Adherence of local agencies to State plan requirements
• § 435.904 — Establishment of outstation locations to process applications for certain low-income eligibility groups
• § 435.905 — Availability and accessibility of program information
• § 435.906 — Opportunity to apply
• § 435.907 — Application
• § 435.908 — Assistance with application and renewal
• § 435.909 — Automatic entitlement to Medicaid following a determination of eligibility under other programs
• § 435.910 — Use of social security number
• § 435.911 — Determination of eligibility
• § 435.912 — Timely determination and redetermination of eligibility
• § 435.914 — Case documentation
• § 435.915 — Effective date
• § 435.916 — Regularly scheduled renewals of Medicaid eligibility
• § 435.917 — Notice of agency's decision concerning eligibility, benefits, or services
• § 435.918 — Use of electronic notices
• § 435.919 — Changes in circumstances
• § 435.920 — Verification of SSNs
• § 435.923 — Authorized representatives
• § 435.926 — Continuous eligibility for children
• § 435.927 — Requirements for States to submit certain data on redeterminations
• § 435.928 — Reduction in FMAP for failure to submit certain data
• § 435.930 — Furnishing Medicaid
• § 435.940 — Basis and scope
• § 435.945 — General requirements
• § 435.948 — Verifying financial information
• § 435.949 — Verification of information through an electronic service
• § 435.952 — Use of information and requests of additional information from individuals
• § 435.956 — Verification of other non-financial information
• § 435.960 — Standardized formats for furnishing and obtaining information to verifying income and eligibility
• § 435.965 — Delay of effective date
• § 435.1000 — Scope
• § 435.1001 — FFP for administration
• § 435.1002 — FFP for services
• § 435.1003 — FFP for redeterminations
• § 435.1004 — Beneficiaries overcoming certain conditions of eligibility
• § 435.1005 — Beneficiaries in institutions eligible under a special income standard
• § 435.1006 — Beneficiaries of optional State supplements only
• § 435.1007 — Categorically needy, medically needy, and qualified Medicare beneficiaries
• § 435.1008 — FFP in expenditures for medical assistance for individuals who have declared citizenship or nationality or satisfactory immigration status
• § 435.1009 — Institutionalized individuals
• § 435.1010 — Definitions relating to institutional status
• § 435.1011 — Requirement for mandatory State supplements
• § 435.1012 — Requirement for maintenance of optional State supplement expenditures
• § 435.1015 — FFP for premium assistance for plans in the individual market
• § 435.1100 — Basis for presumptive eligibility
• § 435.1101 — Definitions related to presumptive eligibility
• § 435.1102 — Children covered under presumptive eligibility
• § 435.1103 — Presumptive eligibility for other individuals
• § 435.1110 — Presumptive eligibility determined by hospitals
• § 435.1200 — Medicaid agency responsibilities for a coordinated eligibility and enrollment process with other insurance affordability programs
• § 435.1205 — Alignment with exchange initial open enrollment period

PART 436

• § 436.1 — Purpose and applicability
• § 436.2 — Basis
• § 436.3 — Definitions and use of terms
• § 436.10 — State plan requirements
• § 436.100 — Scope
• § 436.110 — Individuals receiving cash assistance
• § 436.111 — Individuals who are not eligible for cash assistance because of a requirement not applicable under Medicaid
• § 436.112 — Individuals who would be eligible for cash assistance except for increased OASDI under Pub. L. 92-336 (July 1, 1972)
• § 436.114 — Individuals deemed to be receiving AFDC
• § 436.116 — Families terminated from AFDC because of increased earnings or hours of employment
• § 436.118 — Children for whom adoption assistance or foster care maintenance payments are made
• § 436.120 — Qualified pregnant women and children who are not qualified family members
• § 436.121 — Qualified family members
• § 436.122 — Pregnant women eligible for extended coverage
• § 436.124 — Newborn children
• § 436.128 — Coverage for certain qualified aliens
• § 436.200 — Scope
• § 436.201 — Individuals included in optional groups
• § 436.210 — Individuals who meet the income and resource requirements of the cash assistance programs
• § 436.211 — Individuals who would be eligible for cash assistance if they were not in medical institutions
• § 436.212 — Individuals who would be eligible for cash assistance if the State plan for OAA, AFDC, AB, APTD, or AABD were as broad as allowed under the Act
• § 436.217 — Individuals receiving home and community-based services
• § 436.219 — Individuals receiving State plan home and community-based services
• § 436.220 — Individuals who would meet the income and resource requirements under AFDC if child care costs were paid from earnings
• § 436.222 — Individuals under age 21 who meet the income and resource requirements of AFDC
• § 436.224 — Individuals under age 21 who are under State adoption assistance agreements
• § 436.229 — Optional targeted low-income children
• § 436.230 — Essential spouses of aged, blind, or disabled individuals receiving cash assistance
• § 436.300 — Scope
• § 436.301 — General rules
• § 436.308 — Medically needy coverage of individuals under age 21
• § 436.310 — Medically needy coverage of specified relatives
• § 436.320 — Medically needy coverage of the aged
• § 436.321 — Medically needy coverage of the blind
• § 436.322 — Medically needy coverage of the disabled
• § 436.330 — Coverage for certain aliens
• § 436.400 — Scope
• § 436.401 — General rules
• § 436.402 — [Reserved]
• § 436.403 — State residence
• § 436.404 — Applicant's choice of category
• § 436.406 — Citizenship and alienage
• § 436.407 — Types of acceptable documentary evidence of citizenship
• § 436.408 — [Reserved]
• § 436.500 — Scope
• § 436.510 — Determination of dependency
• § 436.520 — Age requirements for the aged
• § 436.522 — Determination of age
• § 436.530 — Definition of blindness
• § 436.531 — Determination of blindness
• § 436.540 — Definition of disability
• § 436.541 — Determination of disability
• § 436.600 — Scope
• § 436.601 — Application of financial eligibility methodologies
• § 436.602 — Financial responsibility of relatives and other individuals
• § 436.604-436.608 — 436.604-436.608 [Reserved]
• § 436.610 — Assignment of rights to benefits
• § 436.800 — Scope
• § 436.811 — Medically needy income standard: General requirements
• § 436.814 — Medically needy income standard: State plan requirements
• § 436.831 — Income eligibility
• § 436.832 — Post-eligibility treatment of income of institutionalized individuals: Application of patient income to the cost of care
• § 436.840 — Medically needy resource standard: General requirements
• § 436.843 — Medically needy resource standard: State plan requirements
• § 436.845 — Medically needy resource eligibility
• § 436.900 — Scope
• § 436.901 — General requirements
• § 436.909 — Automatic entitlement to Medicaid following a determination of eligibility under other programs
• § 436.1000 — Scope
• § 436.1001 — FFP for administration
• § 436.1002 — FFP for services
• § 436.1003 — beneficiaries overcoming certain conditions of eligibility
• § 436.1004 — FFP in expenditures for medical assistance for individuals who have declared United States citizenship or nationality under section 1137(d) of the Act and with respect to whom the State has not documented citizenship and identity
• § 436.1005 — Institutionalized individuals
• § 436.1006 — Definitions relating to institutional status
• § 436.1100 — Basis and scope
• § 436.1101 — Definitions related to presumptive eligibility period for children
• § 436.1102 — General rules

PART 437

• § 437.1 — Basis, scope, purpose, and applicability
• § 437.5 — Definitions
• § 437.10 — Child, Adult, and Health Home Core Sets
• § 437.15 — Annual reporting on the Child, Adult, and Health Home Core Sets
• § 437.20 — State plan requirements

PART 438

• § 438.1 — Basis and scope
• § 438.2 — Definitions
• § 438.3 — Standard contract requirements
• § 438.4 — Actuarial soundness
• § 438.5 — Rate development standards
• § 438.6 — Special contract provisions related to payment
• § 438.7 — Rate certification submission
• § 438.8 — Medical loss ratio (MLR) standards
• § 438.9 — Provisions that apply to non-emergency medical transportation PAHPs
• § 438.10 — Information requirements
• § 438.12 — Provider discrimination prohibited
• § 438.14 — Requirements that apply to MCO, PIHP, PAHP, PCCM, and PCCM entity contracts involving Indians, Indian health care providers (IHCPs), and Indian managed care entities (IMCEs)
• § 438.16 — In lieu of services and settings (ILOS) requirements
• § 438.50 — State Plan requirements
• § 438.52 — Choice of MCOs, PIHPs, PAHPs, PCCMs, and PCCM entities
• § 438.54 — Managed care enrollment
• § 438.56 — Disenrollment: Requirements and limitations
• § 438.58 — Conflict of interest safeguards
• § 438.60 — Prohibition of additional payments for services covered under MCO, PIHP or PAHP contracts
• § 438.62 — Continued services to enrollees
• § 438.66 — State monitoring requirements
• § 438.68 — Network adequacy standards
• § 438.70 — Stakeholder engagement when LTSS is delivered through a managed care program
• § 438.71 — Beneficiary support system
• § 438.72 — Additional requirements for long-term services and supports
• § 438.74 — State oversight of the minimum MLR requirement
• § 438.100 — Enrollee rights
• § 438.102 — Provider-enrollee communications
• § 438.104 — Marketing activities
• § 438.106 — Liability for payment
• § 438.108 — Cost sharing
• § 438.110 — Member advisory committee
• § 438.114 — Emergency and poststabilization services
• § 438.116 — Solvency standards
• § 438.206 — Availability of services
• § 438.207 — Assurances of adequate capacity and services
• § 438.208 — Coordination and continuity of care
• § 438.210 — Coverage and authorization of services
• § 438.214 — Provider selection
• § 438.224 — Confidentiality
• § 438.228 — Grievance and appeal systems
• § 438.230 — Subcontractual relationships and delegation
• § 438.236 — Practice guidelines
• § 438.242 — Health information systems
• § 438.310 — Basis, scope, and applicability
• § 438.320 — Definitions
• § 438.330 — Quality assessment and performance improvement program
• § 438.332 — State review of the accreditation status of MCOs, PIHPs, and PAHPs
• § 438.334 — [Reserved]
• § 438.340 — Managed care State quality strategy
• § 438.350 — External quality review
• § 438.352 — External quality review protocols
• § 438.354 — Qualifications of external quality review organizations
• § 438.356 — State contract options for external quality review
• § 438.358 — Activities related to external quality review
• § 438.360 — Nonduplication of mandatory activities with Medicare or accreditation review
• § 438.362 — Exemption from external quality review
• § 438.364 — External quality review results
• § 438.370 — Federal financial participation (FFP)
• § 438.400 — Statutory basis, definitions, and applicability
• § 438.402 — General requirements
• § 438.404 — Timely and adequate notice of adverse benefit determination
• § 438.406 — Handling of grievances and appeals
• § 438.408 — Resolution and notification: Grievances and appeals
• § 438.410 — Expedited resolution of appeals
• § 438.414 — Information about the grievance and appeal system to providers and subcontractors
• § 438.416 — Recordkeeping requirements
• § 438.420 — Continuation of benefits while the MCO, PIHP, or PAHP appeal and the State fair hearing are pending
• § 438.424 — Effectuation of reversed appeal resolutions
• § 438.500 — Definitions
• § 438.505 — General rule and applicability
• § 438.510 — Mandatory QRS measure set for Medicaid managed care quality rating system
• § 438.515 — Medicaid managed care quality rating system methodology
• § 438.520 — website display
• § 438.525 — [Reserved]
• § 438.530 — Annual technical resource manual
• § 438.535 — Annual reporting
• § 438.600 — Statutory basis, basic rule, and applicability
• § 438.602 — State responsibilities
• § 438.604 — Data, information, and documentation that must be submitted
• § 438.606 — Source, content, and timing of certification
• § 438.608 — Program integrity requirements under the contract
• § 438.610 — Prohibited affiliations
• § 438.700 — Basis for imposition of sanctions
• § 438.702 — Types of intermediate sanctions
• § 438.704 — Amounts of civil money penalties
• § 438.706 — Special rules for temporary management
• § 438.708 — Termination of an MCO, PCCM or PCCM entity contract
• § 438.710 — Notice of sanction and pre-termination hearing
• § 438.722 — Disenrollment during termination hearing process
• § 438.724 — Notice to CMS
• § 438.726 — State plan requirement
• § 438.730 — Sanction by CMS: Special rules for MCOs
• § 438.802 — Basic requirements
• § 438.806 — Prior approval
• § 438.808 — Exclusion of entities
• § 438.810 — Expenditures for enrollment broker services
• § 438.812 — Costs under risk and nonrisk contracts
• § 438.816 — Expenditures for the beneficiary support system for enrollees using LTSS
• § 438.818 — Enrollee encounter data
• § 438.900 — Meaning of terms
• § 438.905 — Parity requirements for aggregate lifetime and annual dollar limits
• § 438.910 — Parity requirements for financial requirements and treatment limitations
• § 438.915 — Availability of information
• § 438.920 — Applicability
• § 438.930 — Compliance dates

PART 440

• § 440.1 — Basis and purpose
• § 440.2 — Specific definitions; definitions of services for FFP purposes
• § 440.10 — Inpatient hospital services, other than services in an institution for mental diseases
• § 440.20 — Outpatient hospital services and rural health clinic services
• § 440.30 — Other laboratory and X-ray services
• § 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
• § 440.50 — Physicians' services and medical and surgical services of a dentist
• § 440.60 — Medical or other remedial care provided by licensed practitioners
• § 440.70 — Home health services
• § 440.80 — Private duty nursing services
• § 440.90 — Clinic services
• § 440.100 — Dental services
• § 440.110 — Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders
• § 440.120 — Prescribed drugs, dentures, prosthetic devices, and eyeglasses
• § 440.130 — Diagnostic, screening, preventive, and rehabilitative services
• § 440.140 — Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals age 65 or older in institutions for mental diseases
• § 440.150 — Intermediate care facility (ICF/IID) services
• § 440.155 — Nursing facility services, other than in institutions for mental diseases
• § 440.160 — Inpatient psychiatric services for individuals under age 21
• § 440.165 — Nurse-midwife service
• § 440.166 — Nurse practitioner services
• § 440.167 — Personal care services
• § 440.168 — Primary care case management services
• § 440.169 — Case management services
• § 440.170 — Any other medical care or remedial care recognized under State law and specified by the Secretary
• § 440.180 — Home and community-based waiver services
• § 440.181 — Home and community-based services for individuals age 65 or older
• § 440.182 — State plan home and community-based services
• § 440.185 — Respiratory care for ventilator-dependent individuals
• § 440.200 — Basis, purpose, and scope
• § 440.210 — Required services for the categorically needy
• § 440.220 — Required services for the medically needy
• § 440.225 — Optional services
• § 440.230 — Sufficiency of amount, duration, and scope
• § 440.240 — Comparability of services for groups
• § 440.250 — Limits on comparability of services
• § 440.255 — Limited services available to certain aliens
• § 440.260 — Methods and standards to assure quality of services
• § 440.262 — Access and cultural conditions
• § 440.270 — Religious objections
• § 440.300 — Basis
• § 440.305 — Scope
• § 440.310 — Applicability
• § 440.315 — Exempt individuals
• § 440.320 — State plan requirements: Optional enrollment for exempt individuals
• § 440.325 — State plan requirements: Coverage and benefits
• § 440.330 — Benchmark health benefits coverage
• § 440.335 — Benchmark-equivalent health benefits coverage
• § 440.340 — Actuarial report for benchmark-equivalent coverage
• § 440.345 — EPSDT and other required benefits
• § 440.347 — Essential health benefits
• § 440.350 — Employer-sponsored insurance health plans
• § 440.355 — Payment of premiums
• § 440.360 — State plan requirements for providing additional services
• § 440.365 — Coverage of rural health clinic and federally qualified health center (FQHC) services
• § 440.370 — Economy and efficiency
• § 440.375 — Comparability
• § 440.380 — Statewideness
• § 440.385 — Delivery of benchmark and benchmark-equivalent coverage through managed care entities
• § 440.386 — Public notice
• § 440.390 — Assurance of transportation
• § 440.395 — Parity in mental health and substance use disorder benefits

PART 441

• § 441.1 — Purpose
• § 441.10 — Basis
• § 441.11 — Continuation of FFP for institutional services
• § 441.12 — Inpatient hospital tests
• § 441.13 — Prohibitions on FFP: Institutionalized individuals
• § 441.15 — Home health services
• § 441.16 — Home health agency requirements for surety bonds; Prohibition on FFP
• § 441.17 — Laboratory services
• § 441.18 — Case management services
• § 441.20 — Family planning services
• § 441.21 — Nurse-midwife services
• § 441.22 — Nurse practitioner services
• § 441.25 — Prohibition on FFP for certain prescribed drugs
• § 441.30 — Optometric services
• § 441.35 — Organ transplants
• § 441.40 — End-stage renal disease
• § 441.50 — Basis and purpose
• § 441.55 — State plan requirements
• § 441.56 — Required activities
• § 441.57 — Discretionary services
• § 441.58 — Periodicity schedule
• § 441.59 — Treatment of requests for EPSDT screening services
• § 441.60 — Continuing care
• § 441.61 — Utilization of providers and coordination with related programs
• § 441.62 — Transportation and scheduling assistance
• § 441.100 — Basis and purpose
• § 441.101 — State plan requirements
• § 441.102 — Plan of care for institutionalized beneficiaries
• § 441.103 — Alternate plans of care
• § 441.105 — Methods of administration
• § 441.106 — Comprehensive mental health program
• § 441.150 — Basis and purpose
• § 441.151 — General requirements
• § 441.152 — Certification of need for services
• § 441.153 — Team certifying need for services
• § 441.154 — Active treatment
• § 441.155 — Individual plan of care
• § 441.156 — Team developing individual plan of care
• § 441.180 — Maintenance of effort: General rule
• § 441.181 — Maintenance of effort: Explanation of terms and requirements
• § 441.182 — Maintenance of effort: Computation
• § 441.184 — Emergency preparedness
• § 441.200 — Basis and purpose
• § 441.201 — Definition
• § 441.202 — General rule
• § 441.203 — Life of the mother would be endangered
• § 441.204-441.205 — 441.204-441.205 [Reserved]
• § 441.206 — Documentation needed by the Medicaid agency
• § 441.207 — Drugs and devices and termination of ectopic pregnancies
• § 441.208 — Recordkeeping requirements
• § 441.250 — Applicability
• § 441.251 — Definitions
• § 441.252 — State plan requirements
• § 441.253 — Sterilization of a mentally competent individual aged 21 or older
• § 441.254 — Mentally incompetent or institutionalized individuals
• § 441.255 — Sterilization by hysterectomy
• § 441.256 — Additional condition for Federal financial participation (FFP)
• § 441.257 — Informed consent
• § 441.258 — Consent form requirements
• § 441.259 — Review of regulations
• § 441.300 — Basis and purpose
• § 441.301 — Contents of request for a waiver
• § 441.302 — State assurances
• § 441.303 — Supporting documentation required
• § 441.304 — Duration, extension, and amendment of a waiver
• § 441.305 — Replacement of beneficiaries in approved waiver programs
• § 441.306 — Cooperative arrangements with the Maternal and Child Health program
• § 441.307 — Notification of a waiver termination
• § 441.308 — Hearings procedures for waiver terminations
• § 441.310 — Limits on Federal financial participation (FFP)
• § 441.311 — Reporting requirements
• § 441.312 — Home and community-based services quality measure set
• § 441.313 — Website transparency
• § 441.350 — Basis and purpose
• § 441.351 — Contents of a request for a waiver
• § 441.352 — State assurances
• § 441.353 — Supporting documentation required
• § 441.354 — Aggregate projected expenditure limit (APEL)
• § 441.355 — Duration, extension, and amendment of a waiver
• § 441.356 — Waiver termination
• § 441.357 — Hearing procedures for waiver denials
• § 441.360 — Limits on Federal financial participation (FFP)
• § 441.365 — Periodic evaluation, assessment, and review
• § 441.400 — Basis and purpose
• § 441.402 — State plan requirements
• § 441.404 — Minimum protection requirements
• § 441.450 — Basis, scope, and definitions
• § 441.452 — Self-direction: General
• § 441.454 — Use of cash
• § 441.456 — Voluntary disenrollment
• § 441.458 — Involuntary disenrollment
• § 441.460 — Participant living arrangements
• § 441.462 — Statewideness, comparability and limitations on number served
• § 441.464 — State assurances
• § 441.466 — Assessment of need
• § 441.468 — Service plan elements
• § 441.470 — Service budget elements
• § 441.472 — Budget methodology
• § 441.474 — Quality assurance and improvement plan
• § 441.476 — Risk management
• § 441.478 — Qualifications of providers of personal assistance
• § 441.480 — Use of a representative
• § 441.482 — Permissible purchases
• § 441.484 — Financial management services
• § 441.486 — Website transparency
• § 441.500 — Basis and scope
• § 441.505 — Definitions
• § 441.510 — Eligibility
• § 441.515 — Statewideness
• § 441.520 — Included services
• § 441.525 — Excluded services
• § 441.530 — Home and Community-Based Setting
• § 441.535 — Assessment of functional need
• § 441.540 — Person-centered service plan
• § 441.545 — Service models
• § 441.550 — Service plan requirements for self-directed model with service budget
• § 441.555 — Support system
• § 441.560 — Service budget requirements
• § 441.565 — Provider qualifications
• § 441.570 — State assurances
• § 441.575 — Development and Implementation Council
• § 441.580 — Data collection
• § 441.585 — Quality assurance system
• § 441.590 — Increased Federal financial participation
• § 441.595 — Website transparency
• § 441.600 — Basis and purpose
• § 441.605 — General requirements
• § 441.610 — State plan requirements
• § 441.615 — Administration fee requirements
• § 441.700 — Basis and purpose
• § 441.705 — State plan requirements
• § 441.710 — State plan home and community-based services under section 1915(i)(1) of the Act
• § 441.715 — Needs-based criteria and evaluation
• § 441.720 — Independent assessment
• § 441.725 — Person-centered service plan
• § 441.730 — Provider qualifications
• § 441.735 — Definition of individual's representative
• § 441.740 — Self-directed services
• § 441.745 — State plan HCBS administration: State responsibilities and quality improvement
• § 441.750 — Website transparency

PART 442

• § 442.1 — Basis and purpose
• § 442.2 — Terms
• § 442.10 — State plan requirement
• § 442.12 — Provider agreement: General requirements
• § 442.13 — Effective date of provider agreement
• § 442.14 — Effect of change of ownership
• § 442.15 — Duration of agreement for ICF/IIDs
• § 442.16 — [Reserved]
• § 442.30 — Agreement as evidence of certification
• § 442.40 — Availability of FFP during appeals for ICFs/IID
• § 442.42 — FFP under a retroactive provider agreement following appeal
• § 442.43 — Payment transparency reporting
• § 442.100 — State plan requirements
• § 442.101 — Obtaining certification
• § 442.105 — [Reserved]
• § 442.109 — Certification period for ICF/IIDs: General provisions
• § 442.110 — Certification period for ICF/IID with standard-level deficiencies
• § 442.117 — Termination of certification for ICFs/IID whose deficiencies pose immediate jeopardy
• § 442.118 — Denial of payments for new admissions to an ICF/IID
• § 442.119 — Duration of denial of payments and subsequent termination of an ICF/IID

PART 447

• § 447.1 — Purpose
• § 447.10 — Prohibition against reassignment of provider claims
• § 447.15 — Acceptance of State payment as payment in full
• § 447.20 — Provider restrictions: State plan requirements
• § 447.21 — Reduction of payments to providers
• § 447.25 — Direct payments to certain beneficiaries for physicians' or dentists' services
• § 447.26 — Prohibition on payment for provider-preventable conditions
• § 447.30 — Withholding the Federal share of payments to Medicaid providers to recover Medicare overpayments
• § 447.31 — Withholding Medicare payments to recover Medicaid overpayments
• § 447.40 — Payments for reserving beds in institutions
• § 447.45 — Timely claims payment
• § 447.46 — Timely claims payment by MCOs
• § 447.50 — Premiums and cost sharing: Basis and purpose
• § 447.51 — Definitions
• § 447.52 — Cost sharing
• § 447.53 — Cost sharing for drugs
• § 447.54 — Cost sharing for services furnished in a hospital emergency department
• § 447.55 — Premiums
• § 447.56 — Limitations on premiums and cost sharing
• § 447.57 — Beneficiary and public notice requirements
• § 447.88 — Options for claiming FFP payment for section 1920A presumptive eligibility medical assistance payments
• § 447.90 — FFP: Conditions related to pending investigations of credible allegations of fraud against the Medicaid program
• § 447.200 — Basis and purpose
• § 447.201 — State plan requirements
• § 447.202 — Audits
• § 447.203 — Documentation of access to care and service payment rates
• § 447.204 — Medicaid provider participation and public process to inform access to care
• § 447.205 — Public notice of changes in Statewide methods and standards for setting payment rates
• § 447.250 — Basis and purpose
• § 447.251 — Definitions
• § 447.252 — State plan requirements
• § 447.253 — Other requirements
• § 447.255 — Related information
• § 447.256 — Procedures for CMS action on assurances and State plan amendments
• § 447.257 — FFP: Conditions relating to institutional reimbursement
• § 447.271 — Upper limits based on customary charges
• § 447.272 — Inpatient services: Application of upper payment limits
• § 447.280 — Hospital providers of NF services (swing-bed hospitals)
• § 447.294 — Medicaid disproportionate share hospital (DSH) allotment reductions
• § 447.295 — Hospital-specific disproportionate share hospital payment limit: Determination of individuals without health insurance or other third party coverage
• § 447.296 — Limitations on aggregate payments for disproportionate share hospitals for the period January 1, 1992 through September 30, 1992
• § 447.297 — Limitations on aggregate payments for disproportionate share hospitals beginning October 1, 1992
• § 447.298 — State disproportionate share hospital allotments
• § 447.299 — Reporting requirements
• § 447.300 — Basis and purpose
• § 447.302 — State plan requirements
• § 447.304 — Adherence to upper limits; FFP
• § 447.321 — Outpatient hospital and clinic services: Application of upper payment limits
• § 447.325 — Other inpatient and outpatient facility services: Upper limits of payment
• § 447.342 — [Reserved]
• § 447.362 — Upper limits of payment: Nonrisk contract
• § 447.371 — Services furnished by rural health clinics
• § 447.400 — Primary care services furnished by physicians with a specified specialty or subspecialty
• § 447.405 — Amount of required minimum payments
• § 447.410 — State plan requirements
• § 447.415 — Availability of Federal financial participation (FFP)
• § 447.500 — Basis and purpose
• § 447.502 — Definitions
• § 447.504 — Determination of average manufacturer price
• § 447.505 — Determination of best price
• § 447.506 — Authorized generic drugs
• § 447.507 — Identification of inhalation, infusion, instilled, implanted, or injectable drugs (5i drugs)
• § 447.508 — Exclusion from best price of certain sales at a nominal price
• § 447.509 — Medicaid drug rebates (MDR)
• § 447.510 — Requirement and penalties for manufacturers
• § 447.511 — Requirements for States
• § 447.512 — Drugs: Aggregate upper limits of payment
• § 447.514 — Upper limits for multiple source drugs
• § 447.516 — Upper limits for drugs furnished as part of services
• § 447.518 — State plan requirements, findings, and assurances
• § 447.520 — Federal Financial Participation (FFP): Conditions relating to physician-administered drugs
• § 447.522 — Optional coverage of investigational drugs and other drugs not subject to rebate

PART 455

• § 455.1 — Basis and scope
• § 455.2 — Definitions
• § 455.3 — Other applicable regulations
• § 455.12 — State plan requirement
• § 455.13 — Methods for identification, investigation, and referral
• § 455.14 — Preliminary investigation
• § 455.15 — Full investigation
• § 455.16 — Resolution of full investigation
• § 455.17 — Reporting requirements
• § 455.18 — Provider's statements on claims forms
• § 455.19 — Provider's statement on check
• § 455.20 — Beneficiary verification procedure
• § 455.21 — Cooperation with State Medicaid fraud control units
• § 455.23 — Suspension of payments in cases of fraud
• § 455.100 — Purpose
• § 455.101 — Definitions
• § 455.102 — Determination of ownership or control percentages
• § 455.103 — State plan requirement
• § 455.104 — Disclosure by Medicaid providers and fiscal agents: Information on ownership and control
• § 455.105 — Disclosure by providers: Information related to business transactions
• § 455.106 — Disclosure by providers: Information on persons convicted of crimes
• § 455.107 — Disclosure of affiliations
• § 455.200 — Basis and scope
• § 455.202 — Limitation on contractor liability
• § 455.230 — Eligibility requirements
• § 455.232 — Medicaid integrity audit program contractor functions
• § 455.234 — Awarding of a contract
• § 455.236 — Renewal of a contract
• § 455.238 — Conflict of interest
• § 455.240 — Conflict of interest resolution
• § 455.300 — Purpose
• § 455.301 — Definitions
• § 455.304 — Condition for Federal financial participation (FFP)
• § 455.400 — Purpose
• § 455.405 — State plan requirements
• § 455.410 — Enrollment and screening of providers
• § 455.412 — Verification of provider licenses
• § 455.414 — Revalidation of enrollment
• § 455.416 — Termination or denial of enrollment
• § 455.417 — Termination periods and termination database periods
• § 455.420 — Reactivation of provider enrollment
• § 455.422 — Appeal rights
• § 455.432 — Site visits
• § 455.434 — Criminal background checks
• § 455.436 — Federal database checks
• § 455.440 — National Provider Identifier
• § 455.450 — Screening levels for Medicaid providers
• § 455.452 — Other State screening methods
• § 455.460 — Application fee
• § 455.470 — Temporary moratoria
• § 455.500 — Purpose
• § 455.502 — Establishment of program
• § 455.504 — Definitions
• § 455.506 — Activities to be conducted by Medicaid RACs and States
• § 455.508 — Eligibility requirements for Medicaid RACs
• § 455.510 — Payments to RACs
• § 455.512 — Medicaid RAC provider appeals
• § 455.514 — Federal share of State expense of the Medicaid RAC program
• § 455.516 — Exceptions from Medicaid RAC programs
• § 455.518 — Applicability to the territories

PART 456

• § 456.1 — Basis and purpose of part
• § 456.2 — State plan requirements
• § 456.3 — Statewide surveillance and utilization control program
• § 456.4 — Responsibility for monitoring the utilization control program
• § 456.5 — Evaluation criteria
• § 456.6 — Review by State medical agency of appropriateness and quality of services
• § 456.21 — Scope
• § 456.22 — Sample basis evaluation of services
• § 456.23 — Post-payment review process
• § 456.50 — Scope
• § 456.51 — Definitions
• § 456.60 — Certification and recertification of need for inpatient care
• § 456.80 — Individual written plan of care
• § 456.100 — Scope
• § 456.101 — UR plan required for inpatient hospital services
• § 456.105 — UR committee required
• § 456.106 — Organization and composition of UR committee; disqualification from UR committee membership
• § 456.111 — Beneficiary information required for UR
• § 456.112 — Records and reports
• § 456.113 — Confidentiality
• § 456.121 — Admission review required
• § 456.122 — Evaluation criteria for admission review
• § 456.123 — Admission review process
• § 456.124 — Notification of adverse decision
• § 456.125 — Time limits for admission review
• § 456.126 — Time limits for final decision and notification of adverse decision
• § 456.127 — Pre-admission review
• § 456.128 — Initial continued stay review date
• § 456.129 — Description of methods and criteria: Initial continued stay review date; close professional scrutiny; length of stay modification
• § 456.131 — Continued stay review required
• § 456.132 — Evaluation criteria for continued stay
• § 456.133 — Subsequent continued stay review dates
• § 456.134 — Description of methods and criteria: Subsequent continued stay review dates; length of stay modification
• § 456.135 — Continued stay review process
• § 456.136 — Notification of adverse decision
• § 456.137 — Time limits for final decision and notification of adverse decision
• § 456.141 — Purpose and general description
• § 456.142 — UR plan requirements for medical care evaluation studies
• § 456.143 — Content of medical care evaluation studies
• § 456.144 — Data sources for studies
• § 456.145 — Number of studies required to be performed
• § 456.150 — Scope
• § 456.151 — Definitions
• § 456.160 — Certification and recertification of need for inpatient care
• § 456.170 — Medical, psychiatric, and social evaluations
• § 456.171 — [Reserved]
• § 456.180 — Individual written plan of care
• § 456.181 — Reports of evaluations and plans of care
• § 456.200 — Scope
• § 456.201 — UR plan required for inpatient mental hospital services
• § 456.205 — UR committee required
• § 456.206 — Organization and composition of UR committee; disqualification from UR committee membership
• § 456.211 — Beneficiary information required for UR
• § 456.212 — Records and reports
• § 456.213 — Confidentiality
• § 456.231 — Continued stay review required
• § 456.232 — Evaluation criteria for continued stay
• § 456.233 — Initial continued stay review date
• § 456.234 — Subsequent continued stay review dates
• § 456.235 — Description of methods and criteria: Continued stay review dates; length of stay modification
• § 456.236 — Continued stay review process
• § 456.237 — Notification of adverse decision
• § 456.238 — Time limits for final decision and notification of adverse decision
• § 456.241 — Purpose and general description
• § 456.242 — UR plan requirements for medical care evaluation studies
• § 456.243 — Content of medical care evaluation studies
• § 456.244 — Data sources for studies
• § 456.245 — Number of studies required to be performed
• § 456.350 — Scope
• § 456.351 — Definition
• § 456.360 — Certification and recertification of need for inpatient care
• § 456.370 — Medical, psychological, and social evaluations
• § 456.371 — Exploration of alternative services
• § 456.372 — Medicaid agency review of need for admission
• § 456.380 — Individual written plan of care
• § 456.381 — Reports of evaluations and plans of care
• § 456.400 — Scope
• § 456.401 — State plan UR requirements and options; UR plan required for intermediate care facility services
• § 456.405 — Description of UR review function: How and when
• § 456.406 — Description of UR review function: Who performs UR; disqualification from performing UR
• § 456.407 — UR responsibilities of administrative staff
• § 456.411 — Beneficiary information required for UR
• § 456.412 — Records and reports
• § 456.413 — Confidentiality
• § 456.431 — Continued stay review required
• § 456.432 — Evaluation criteria for continued stay
• § 456.433 — Initial continued stay review date
• § 456.434 — Subsequent continued stay review dates
• § 456.435 — Description of methods and criteria: Continued stay review dates
• § 456.436 — Continued stay review process
• § 456.437 — Notification of adverse decision
• § 456.438 — Time limits for notification of adverse decision
• § 456.480 — Scope
• § 456.481 — Admission certification and plan of care
• § 456.482 — Medical, psychiatric, and social evaluations
• § 456.500 — Purpose
• § 456.501 — UR plans as a condition for FFP
• § 456.505 — Applicability of waiver
• § 456.506 — Waiver options for Medicaid agency
• § 456.507 — Review and granting of waiver requests
• § 456.508 — Withdrawal of waiver
• § 456.520 — Definitions
• § 456.521 — Conditions for granting variance requests
• § 456.522 — Content of request for variance
• § 456.523 — Revised UR plan
• § 456.524 — Notification of Administrator's action and duration of variance
• § 456.525 — Request for renewal of variance
• § 456.600 — Purpose
• § 456.601 — Definitions
• § 456.602 — Inspection team
• § 456.603 — Financial interests and employment of team members
• § 456.604 — Physician team member inspecting care of beneficiaries
• § 456.605 — Number and location of teams
• § 456.606 — Frequency of inspections
• § 456.607 — Notification before inspection
• § 456.608 — Personal contact with and observation of beneficiaries and review of records
• § 456.609 — Determinations by team
• § 456.610 — Basis for determinations
• § 456.611 — Reports on inspections
• § 456.612 — Copies of reports
• § 456.613 — Action on reports
• § 456.614 — Inspections by utilization review committee
• § 456.650 — Basis, purpose and scope
• § 456.651 — Definitions
• § 456.652 — Requirements for an effective utilization control program
• § 456.653 — Acceptable reasons for not meeting requirements for annual on-site review
• § 456.654 — Requirements for content of showings and procedures for submittal
• § 456.655 — Validation of showings
• § 456.656 — Reductions in FFP
• § 456.657 — Computation of reductions in FFP
• § 456.700 — Scope
• § 456.702 — Definitions
• § 456.703 — Drug use review program
• § 456.705 — Prospective drug review
• § 456.709 — Retrospective drug use review
• § 456.711 — Educational program
• § 456.712 — Annual report
• § 456.714 — DUR/surveillance and utilization review relationship
• § 456.716 — DUR Board
• § 456.719 — Funding for DUR program
• § 456.722 — Electronic claims management system
• § 456.725 — Funding of ECM system

PART 457

• § 457.1 — Program description
• § 457.2 — Basis and scope of subchapter D
• § 457.10 — Definitions and use of terms
• § 457.30 — Basis, scope, and applicability of subpart A
• § 457.40 — State program administration
• § 457.50 — State plan
• § 457.60 — Amendments
• § 457.65 — Effective date and duration of State plans and plan amendments
• § 457.70 — Program options
• § 457.80 — Current State child health insurance coverage and coordination
• § 457.90 — Outreach
• § 457.110 — Enrollment assistance and information requirements
• § 457.120 — Public involvement in program development
• § 457.125 — Provision of child health assistance to American Indian and Alaska Native children
• § 457.130 — Civil rights assurance
• § 457.135 — Assurance of compliance with other provisions
• § 457.140 — Budget
• § 457.150 — CMS review of State plan material
• § 457.160 — Notice and timing of CMS action on State plan material
• § 457.170 — Withdrawal process
• § 457.200 — Program reviews
• § 457.202 — Audits
• § 457.203 — Administrative and judicial review of action on State plan material
• § 457.204 — Withholding of payment for failure to comply with Federal requirements
• § 457.206 — Administrative appeals under CHIP
• § 457.208 — Judicial review
• § 457.216 — Treatment of uncashed or canceled (voided) CHIP checks
• § 457.220 — Funds from units of government as the State share of financial participation
• § 457.222 — FFP for equipment
• § 457.224 — FFP: Conditions relating to cost sharing
• § 457.226 — Fiscal policies and accountability
• § 457.228 — Cost allocation
• § 457.230 — FFP for State ADP expenditures
• § 457.232 — Refunding of Federal Share of CHIP overpayments to providers and referral of allegations of waste, fraud or abuse to the Office of Inspector General
• § 457.236 — Audits
• § 457.238 — Documentation of payment rates
• § 457.300 — Basis, scope, and applicability
• § 457.301 — Definitions and use of terms
• § 457.305 — State plan provisions
• § 457.310 — Targeted low-income child
• § 457.315 — Application of modified adjusted gross income and household definition
• § 457.320 — Other eligibility standards
• § 457.330 — Application
• § 457.340 — Application for and enrollment in CHIP
• § 457.342 — Continuous eligibility for children
• § 457.343 — Periodic renewal of CHIP eligibility
• § 457.344 — Changes in circumstances
• § 457.348 — Determinations of Children's Health Insurance Program eligibility by other insurance affordability programs
• § 457.350 — Eligibility screening and enrollment in other insurance affordability programs
• § 457.351 — Coordination involving appeals entities for different insurance affordability programs
• § 457.353 — Monitoring and evaluation of screening process
• § 457.355 — Presumptive eligibility for children
• § 457.360 — Deemed newborn children
• § 457.370 — Alignment with Exchange initial open enrollment period
• § 457.380 — Eligibility verification
• § 457.401 — Basis, scope, and applicability
• § 457.402 — Definition of child health assistance
• § 457.410 — Health benefits coverage options
• § 457.420 — Benchmark health benefits coverage
• § 457.430 — Benchmark-equivalent health benefits coverage
• § 457.431 — Actuarial report for benchmark-equivalent coverage
• § 457.440 — Existing comprehensive State-based coverage
• § 457.450 — Secretary-approved coverage
• § 457.470 — Prohibited coverage
• § 457.475 — Limitations on coverage: Abortions
• § 457.480 — Prohibited coverage limitations, preexisting condition exclusions, and relation to other laws
• § 457.490 — Delivery and utilization control systems
• § 457.495 — State assurance of access to care and procedures to assure quality and appropriateness of care
• § 457.496 — Parity in mental health and substance use disorder benefits
• § 457.500 — Basis, scope, and applicability
• § 457.505 — General State plan requirements
• § 457.510 — Premiums, enrollment fees, or similar fees: State plan requirements
• § 457.515 — Co-payments, coinsurance, deductibles, or similar cost-sharing charges: State plan requirements
• § 457.520 — Cost sharing for well-baby and well-child care services
• § 457.525 — Public schedule
• § 457.530 — General cost-sharing protection for lower income children
• § 457.535 — Cost-sharing protection to ensure enrollment of American Indians and Alaska Natives
• § 457.540 — Cost-sharing charges for children in families with incomes at or below 150 percent of the FPL
• § 457.555 — Maximum allowable cost-sharing charges on targeted low-income children in families with income from 101 to 150 percent of the FPL
• § 457.560 — Cumulative cost-sharing maximum
• § 457.570 — Disenrollment protections
• § 457.600 — Purpose and basis of this subpart
• § 457.602 — Applicability
• § 457.606 — Conditions for State allotments and Federal payments for a fiscal year
• § 457.608 — Process and calculation of State allotments prior to FY 2009
• § 457.609 — Process and calculation of State allotments for a fiscal year after FY 2008
• § 457.610 — Period of availability for State allotments prior to FY 2009
• § 457.611 — Period of availability for State allotments for a fiscal year after FY 2008
• § 457.614 — General payment process
• § 457.616 — Application and tracking of payments against the fiscal year allotments
• § 457.618 — Ten percent limit on certain Children's Health Insurance Program expenditures
• § 457.622 — Rate of FFP for State expenditures
• § 457.626 — Prevention of duplicate payments
• § 457.628 — Other applicable Federal regulations
• § 457.630 — Grants procedures
• § 457.700 — Basis, scope, and applicability
• § 457.710 — State plan requirements: Strategic objectives and performance goals
• § 457.720 — State plan requirement: State assurance regarding data collection, records, and reports
• § 457.730 — Beneficiary access to and exchange of data
• § 457.731 — Access to and exchange of health data for providers and payers
• § 457.732 — Prior authorization requirements
• § 457.740 — State expenditures and statistical reports
• § 457.750 — Annual report
• § 457.760 — Access to published provider directory information
• § 457.770 — Reporting on Health Care Quality Measures
• § 457.800 — Basis, scope, and applicability
• § 457.805 — State plan requirement: Procedures to address substitution under group health plans
• § 457.810 — Premium assistance programs: Required protections against substitution
• § 457.900 — Basis, scope and applicability
• § 457.910 — State program administration
• § 457.915 — Fraud detection and investigation
• § 457.925 — Preliminary investigation
• § 457.930 — Full investigation, resolution, and reporting requirements
• § 457.935 — Sanctions and related penalties
• § 457.940 — Procurement standards
• § 457.945 — Certification for contracts and proposals
• § 457.950 — Contract and payment requirements including certification of payment-related information
• § 457.965 — Documentation
• § 457.980 — Verification of enrollment and provider services received
• § 457.985 — Integrity of professional advice to enrollees
• § 457.990 — Provider and supplier screening, oversight, and reporting requirements
• § 457.1000 — Basis, scope, and applicability
• § 457.1003 — CMS review of waiver requests
• § 457.1005 — Cost-effective coverage through a community-based health delivery system
• § 457.1010 — Purchase of family coverage
• § 457.1015 — Cost-effectiveness
• § 457.1100 — Basis, scope and applicability
• § 457.1110 — Privacy protections
• § 457.1120 — State plan requirement: Description of review process
• § 457.1130 — Program specific review process: Matters subject to review
• § 457.1140 — Program specific review process: Core elements of review
• § 457.1150 — Program specific review process: Impartial review
• § 457.1160 — Program specific review process: Time frames
• § 457.1170 — Program specific review process: Continuation of enrollment
• § 457.1180 — Program specific review process: Notice
• § 457.1190 — Application of review procedures when States offer premium assistance for group health plans
• § 457.1200 — Basis, scope, and applicability
• § 457.1201 — Standard contract requirements
• § 457.1203 — Rate development standards and medical loss ratio
• § 457.1206 — Non-emergency medical transportation PAHPs
• § 457.1207 — Information requirements
• § 457.1208 — Provider discrimination prohibited
• § 457.1209 — Requirements that apply to MCO, PIHP, PAHP, PCCM, and PCCM entity contracts involving Indians, Indian health care provider (IHCP), and Indian managed care entities (IMCE)
• § 457.1210 — Enrollment process
• § 457.1212 — Disenrollment
• § 457.1214 — Conflict of interest safeguards
• § 457.1216 — Continued services to enrollees
• § 457.1218 — Network adequacy standards
• § 457.1220 — Enrollee rights
• § 457.1222 — Provider-enrollee communication
• § 457.1224 — Marketing activities
• § 457.1226 — Liability for payment
• § 457.1228 — Emergency and poststabilization services
• § 457.1230 — Access standards
• § 457.1233 — Structure and operation standards
• § 457.1240 — Quality measurement and improvement
• § 457.1250 — External quality review
• § 457.1260 — Grievance system
• § 457.1270 — Sanctions
• § 457.1280 — Conditions necessary to contract as an MCO, PAHP, or PIHP
• § 457.1285 — Program integrity safeguards

PART 460

• § 460.2 — Basis
• § 460.3 — Part D program requirements
• § 460.4 — Scope and purpose
• § 460.6 — Definitions
• § 460.10 — Purpose
• § 460.12 — Application requirements
• § 460.14 — [Reserved]
• § 460.16 — [Reserved]
• § 460.18 — CMS evaluation of applications
• § 460.19 — Issuance of compliance actions for failure to comply with the terms of the PACE program agreement
• § 460.20 — Notice of CMS determination
• § 460.24 — Limit on number of PACE program agreements
• § 460.26 — Submission and evaluation of waiver requests
• § 460.28 — Notice of CMS determination on waiver requests
• § 460.30 — Program agreement requirement
• § 460.32 — Content and terms of PACE program agreement
• § 460.34 — Duration of PACE program agreement
• § 460.40 — Violations for which CMS may impose sanctions
• § 460.42 — Suspension of enrollment or payment by CMS
• § 460.46 — Civil money penalties
• § 460.48 — Additional actions by CMS or the State
• § 460.50 — Termination of PACE program agreement
• § 460.52 — Transitional care during termination
• § 460.54 — Termination procedures
• § 460.56 — Procedures for imposing sanctions and civil money penalties
• § 460.60 — PACE organizational structure
• § 460.62 — Governing body
• § 460.63 — Compliance oversight requirements
• § 460.64 — Personnel qualifications for staff with direct participant contact
• § 460.66 — Training
• § 460.68 — Program integrity
• § 460.70 — Contracted services
• § 460.71 — Oversight of direct participant care
• § 460.72 — Physical environment
• § 460.74 — Infection control
• § 460.76 — Transportation services
• § 460.78 — Dietary services
• § 460.80 — Fiscal soundness
• § 460.82 — Marketing
• § 460.84 — Emergency preparedness
• § 460.86 — Payment to individuals and entities excluded by the OIG or included on the preclusion list
• § 460.90 — PACE benefits under Medicare and Medicaid
• § 460.92 — Required services
• § 460.94 — Required services for Medicare participants
• § 460.96 — Excluded services
• § 460.98 — Service delivery
• § 460.100 — Emergency care
• § 460.102 — Interdisciplinary team
• § 460.104 — Participant assessment
• § 460.106 — Plan of care
• § 460.110 — Bill of rights
• § 460.112 — Specific rights to which a participant is entitled
• § 460.114 — Restraints
• § 460.116 — Explanation of rights
• § 460.118 — Violation of rights
• § 460.119 — Resolution of complaints in the complaints tracking module
• § 460.120 — Grievance process
• § 460.121 — Service determination process
• § 460.122 — PACE organization's appeals process
• § 460.124 — Additional appeal rights under Medicare or Medicaid
• § 460.130 — General rule
• § 460.132 — Quality improvement plan
• § 460.134 — Minimum requirements for quality improvement program
• § 460.136 — Internal quality improvement activities
• § 460.138 — Committees with community input
• § 460.150 — Eligibility to enroll in a PACE program
• § 460.152 — Enrollment process
• § 460.154 — Enrollment agreement
• § 460.156 — Other enrollment procedures
• § 460.158 — Effective date of enrollment
• § 460.160 — Continuation of enrollment
• § 460.162 — Voluntary disenrollment
• § 460.164 — Involuntary disenrollment
• § 460.166 — Disenrollment responsibilities
• § 460.168 — Reinstatement in other Medicare and Medicaid programs
• § 460.170 — Reinstatement in PACE
• § 460.172 — Documentation of disenrollment
• § 460.180 — Medicare payment to PACE organizations
• § 460.182 — Medicaid payment
• § 460.184 — Post-eligibility treatment of income
• § 460.186 — PACE premiums
• § 460.190 — Monitoring during trial period
• § 460.192 — Ongoing monitoring after trial period
• § 460.194 — Corrective action
• § 460.196 — Disclosure of review results
• § 460.198 — Disclosure of compliance deficiencies
• § 460.200 — Maintenance of records and reporting of data
• § 460.202 — Participant health outcomes data
• § 460.204 — Financial recordkeeping and reporting requirements
• § 460.208 — Financial statements
• § 460.210 — Medical records

PART 475

• § 475.1 — Definitions
• § 475.100 — Scope and applicability
• § 475.101 — Eligibility requirements for QIO contracts
• § 475.102 — Requirements for performing case reviews
• § 475.103 — Requirements for performing quality improvement initiatives
• § 475.104 — [Reserved]
• § 475.105 — Prohibition against contracting with health care facilities, affiliates, and payor organizations
• § 475.106 — [Reserved]
• § 475.107 — QIO contract awards

PART 476

• § 476.1 — Definitions
• § 476.70 — Statutory bases and applicability
• § 476.71 — QIO review requirements
• § 476.73 — Notification of QIO designation and implementation of review
• § 476.74 — General requirements for the assumption of review
• § 476.76 — Cooperation with health care facilities
• § 476.78 — Responsibilities of providers and practitioners
• § 476.80 — Coordination with Medicare administrative contractors, fiscal intermediaries, and carriers
• § 476.82 — Continuation of functions not assumed by QIOs
• § 476.83 — Initial denial determinations
• § 476.84 — Changes as a result of DRG validation
• § 476.85 — Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations
• § 476.86 — Correlation of Title XI functions with Title XVIII functions
• § 476.88 — Examination of the operations and records of health care facilities and practitioners
• § 476.90 — Lack of cooperation by a provider or practitioner
• § 476.93 — Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation
• § 476.94 — Notice of QIO initial denial determination and changes as a result of a DRG validation
• § 476.96 — Review period and reopening of initial denial determinations and changes as a result of DRG validations
• § 476.98 — Reviewer qualifications and participation
• § 476.100 — Use of norms and criteria
• § 476.102 — Involvement of health care practitioners other than physicians
• § 476.104 — Coordination of activities
• § 476.110 — Use of immediate advocacy to resolve oral beneficiary complaints
• § 476.120 — Submission of written beneficiary complaints
• § 476.130 — Beneficiary complaint review procedures
• § 476.140 — Beneficiary complaint reconsideration procedures
• § 476.150 — Abandoned complaints and reopening rights
• § 476.160 — General quality of care review procedures
• § 476.170 — General quality of care reconsideration procedures

PART 478

• § 478.10 — Scope
• § 478.12 — Statutory basis
• § 478.14 — Applicability
• § 478.15 — QIO review of changes resulting from DRG validation
• § 478.16 — Right to reconsideration
• § 478.18 — Location for submitting requests for reconsideration
• § 478.20 — Time limits for requesting reconsideration
• § 478.22 — Good cause for late filing of a request for a reconsideration or hearing
• § 478.24 — Opportunity for a party to obtain and submit information
• § 478.26 — Delegation of the reconsideration function
• § 478.28 — Qualifications of a reconsideration reviewer
• § 478.30 — Evidence to be considered by the reconsideration reviewer
• § 478.32 — Time limits for issuance of the reconsidered determination
• § 478.34 — Notice of a reconsidered determination
• § 478.36 — Record of reconsideration
• § 478.38 — Effect of a reconsidered determination
• § 478.40 — Beneficiary's right to a hearing
• § 478.42 — Submitting a request for a hearing
• § 478.44 — Determining the amount in controversy for a hearing
• § 478.46 — Medicare Appeals Council and judicial review
• § 478.48 — Reopening and revision of a reconsidered determination or a decision

PART 480

• § 480.101 — Scope and definitions
• § 480.102 — Statutory bases for acquisition and maintenance of information
• § 480.103 — Statutory bases for disclosure of information
• § 480.104 — Procedures for disclosure by a QIO
• § 480.105 — Notice of disclosures made by a QIO
• § 480.106 — Exceptions to QIO notice requirements
• § 480.107 — Limitations on redisclosure
• § 480.108 — Penalties for unauthorized disclosure
• § 480.109 — Applicability of other statutes and regulations
• § 480.111 — QIO access to records and information of institutions and practitioners
• § 480.112 — QIO access to records and information of intermediaries and carriers
• § 480.113 — QIO access to information collected for QIO purposes
• § 480.114 — Limitation on data collection
• § 480.115 — Requirements for maintaining confidentiality
• § 480.116 — Notice to individuals and institutions under review
• § 480.120 — Information subject to disclosure
• § 480.121 — Optional disclosure of nonconfidential information
• § 480.130 — Disclosure to the Department
• § 480.131 — Access to medical records for the monitoring of QIOs
• § 480.132 — Disclosure of information about patients
• § 480.133 — Disclosure of information about practitioners, reviewers and institutions
• § 480.134 — Verification and amendment of QIO information
• § 480.135 — Disclosure necessary to perform review responsibilities
• § 480.136 — Disclosure to intermediaries and carriers
• § 480.137 — Disclosure to Federal and State enforcement agencies responsible for the investigation or identification of fraud or abuse of the Medicare or Medicaid programs
• § 480.138 — Disclosure for other specified purposes
• § 480.139 — Disclosure of QIO deliberations and decisions
• § 480.140 — Disclosure of quality review study information
• § 480.141 — Disclosure of QIO interpretations on the quality of health care
• § 480.142 — Disclosure of sanction reports
• § 480.143 — QIO involvement in shared health data systems
• § 480.144 — Access to QIO data and information
• § 480.145 — Beneficiary authorization of use of confidential information

PART 482

• § 482.1 — Basis and scope
• § 482.2 — Provision of emergency services by nonparticipating hospitals
• § 482.11 — Condition of participation: Compliance with Federal, State and local laws
• § 482.12 — Condition of participation: Governing body
• § 482.13 — Condition of participation: Patient's rights
• § 482.15 — Condition of participation: Emergency preparedness
• § 482.21 — Condition of participation: Quality assessment and performance improvement program
• § 482.22 — Condition of participation: Medical staff
• § 482.23 — Condition of participation: Nursing services
• § 482.24 — Condition of participation: Medical record services
• § 482.25 — Condition of participation: Pharmaceutical services
• § 482.26 — Condition of participation: Radiologic services
• § 482.27 — Condition of participation: Laboratory services
• § 482.28 — Condition of participation: Food and dietetic services
• § 482.30 — Condition of participation: Utilization review
• § 482.41 — Condition of participation: Physical environment
• § 482.42 — Condition of participation: Infection prevention and control and antibiotic stewardship programs
• § 482.43 — Condition of participation: Discharge planning
• § 482.45 — Condition of participation: Organ, tissue, and eye procurement
• § 482.51 — Condition of participation: Surgical services
• § 482.52 — Condition of participation: Anesthesia services
• § 482.53 — Condition of participation: Nuclear medicine services
• § 482.54 — Condition of participation: Outpatient services
• § 482.55 — Condition of participation: Emergency services
• § 482.56 — Condition of participation: Rehabilitation services
• § 482.57 — Condition of participation: Respiratory care services
• § 482.58 — Special requirements for hospital providers of long-term care services (“swing-beds”)
• § 482.59 — Condition of participation: Obstetrical services
• § 482.60 — Special provisions applying to psychiatric hospitals
• § 482.61 — Condition of participation: Special medical record requirements for psychiatric hospitals
• § 482.62 — Condition of participation: Special staff requirements for psychiatric hospitals
• § 482.68 — Special requirement for transplant programs
• § 482.70 — Definitions
• § 482.72 — Condition of participation: OPTN membership
• § 482.74 — Condition of participation: Notification to CMS
• § 482.76 — Condition of participation: Pediatric Transplants
• § 482.78 — Condition of participation: Emergency preparedness for transplant programs
• § 482.80 — Condition of participation: Data submission, clinical experience, and outcome requirements for initial approval of transplant programs
• § 482.90 — Condition of participation: Patient and living donor selection
• § 482.92 — Condition of participation: Organ recovery and receipt
• § 482.94 — Condition of participation: Patient and living donor management
• § 482.96 — Condition of participation: Quality assessment and performance improvement (QAPI)
• § 482.98 — Condition of participation: Human resources
• § 482.100 — Condition of participation: Organ procurement
• § 482.102 — Condition of participation: Patient and living donor rights
• § 482.104 — Condition of participation: Additional requirements for kidney transplant programs

PART 483

• § 483.1 — Basis and scope
• § 483.5 — Definitions
• § 483.10 — Resident rights
• § 483.12 — Freedom from abuse, neglect, and exploitation
• § 483.15 — Admission, transfer, and discharge rights
• § 483.20 — Resident assessment
• § 483.21 — Comprehensive person-centered care planning
• § 483.24 — Quality of life
• § 483.25 — Quality of care
• § 483.30 — Physician services
• § 483.35 — Nursing services
• § 483.40 — Behavioral health services
• § 483.45 — Pharmacy services
• § 483.50 — Laboratory, radiology, and other diagnostic services
• § 483.55 — Dental services
• § 483.60 — Food and nutrition services
• § 483.65 — Specialized rehabilitative services
• § 483.70 — Administration
• § 483.71 — Facility assessment
• § 483.73 — Emergency preparedness
• § 483.75 — Quality assurance and performance improvement
• § 483.80 — Infection control
• § 483.85 — Compliance and ethics program
• § 483.90 — Physical environment
• § 483.95 — Training requirements
• § 483.100 — Basis
• § 483.102 — Applicability and definitions
• § 483.104 — State plan requirement
• § 483.106 — Basic rule
• § 483.108 — Relationship of PASARR to other Medicaid processes
• § 483.110 — Out-of-State arrangements
• § 483.112 — Preadmission screening of applicants for admission to NFs
• § 483.114 — Annual review of NF residents
• § 483.116 — Residents and applicants determined to require NF level of services
• § 483.118 — Residents and applicants determined not to require NF level of services
• § 483.120 — Specialized services
• § 483.122 — FFP for NF services
• § 483.124 — FFP for specialized services
• § 483.126 — Appropriate placement
• § 483.128 — PASARR evaluation criteria
• § 483.130 — PASARR determination criteria
• § 483.132 — Evaluating the need for NF services and NF level of care (PASARR/NF)
• § 483.134 — Evaluating whether an individual with mental illness requires specialized services (PASARR/MI)
• § 483.136 — Evaluating whether an individual with intellectual disability requires specialized services (PASARR/IID)
• § 483.138 — Maintenance of services and availability of FFP
• § 483.150 — Statutory basis; Deemed meeting or waiver of requirements
• § 483.151 — State review and approval of nurse aide training and competency evaluation programs
• § 483.152 — Requirements for approval of a nurse aide training and competency evaluation program
• § 483.154 — Nurse aide competency evaluation
• § 483.156 — Registry of nurse aides
• § 483.158 — FFP for nurse aide training and competency evaluation
• § 483.160 — Requirements for training of paid feeding assistants
• § 483.200 — Statutory basis
• § 483.202 — Definitions
• § 483.204 — Provision of a hearing and appeal system
• § 483.206 — Transfers, discharges and relocations subject to appeal
• § 483.315 — Specification of resident assessment instrument
• § 483.350 — Basis and scope
• § 483.352 — Definitions
• § 483.354 — General requirements for psychiatric residential treatment facilities
• § 483.356 — Protection of residents
• § 483.358 — Orders for the use of restraint or seclusion
• § 483.360 — Consultation with treatment team physician
• § 483.362 — Monitoring of the resident in and immediately after restraint
• § 483.364 — Monitoring of the resident in and immediately after seclusion
• § 483.366 — Notification of parent(s) or legal guardian(s)
• § 483.368 — Application of time out
• § 483.370 — Postintervention debriefings
• § 483.372 — Medical treatment for injuries resulting from an emergency safety intervention
• § 483.374 — Facility reporting
• § 483.376 — Education and training
• § 483.400 — Basis and purpose
• § 483.405 — Relationship to other HHS regulations
• § 483.410 — Condition of participation: Governing body and management
• § 483.420 — Condition of participation: Client protections
• § 483.430 — Condition of participation: Facility staffing
• § 483.440 — Condition of participation: Active treatment services
• § 483.450 — Condition of participation: Client behavior and facility practices
• § 483.460 — Condition of participation: Health care services
• § 483.470 — Condition of participation: Physical environment
• § 483.475 — Condition of participation: Emergency preparedness
• § 483.480 — Condition of participation: Dietetic services

PART 484

• § 484.1 — Basis and scope
• § 484.2 — Definitions
• § 484.40 — Condition of participation: Release of patient identifiable OASIS information
• § 484.45 — Condition of participation: Reporting OASIS information
• § 484.50 — Condition of participation: Patient rights
• § 484.55 — Condition of participation: Comprehensive assessment of patients
• § 484.58 — Condition of participation: Discharge planning
• § 484.60 — Condition of participation: Care planning, coordination of services, and quality of care
• § 484.65 — Condition of participation: Quality assessment and performance improvement (QAPI)
• § 484.70 — Condition of participation: Infection prevention and control
• § 484.75 — Condition of participation: Skilled professional services
• § 484.80 — Condition of participation: Home health aide services
• § 484.100 — Condition of participation: Compliance with Federal, State, and local laws and regulations related to the health and safety of patients
• § 484.102 — Condition of participation: Emergency preparedness
• § 484.105 — Condition of participation: Organization and administration of services
• § 484.110 — Condition of participation: Clinical records
• § 484.115 — Condition of participation: Personnel qualifications
• § 484.200 — Basis and scope
• § 484.202 — Definitions
• § 484.205 — Basis of payment
• § 484.215 — Initial establishment of the calculation of the national, standardized prospective payment rates
• § 484.220 — Calculation of the case-mix and wage area adjusted prospective payment rates
• § 484.225 — Annual update of the unadjusted national, standardized prospective payment rates
• § 484.230 — Low-utilization payment adjustments
• § 484.235 — Partial payment adjustments
• § 484.240 — Outlier payments
• § 484.245 — Requirements under the Home Health Quality Reporting Program (HH QRP)
• § 484.250 — OASIS data
• § 484.260 — Limitation on review
• § 484.265 — Additional payment
• § 484.300 — Basis and scope of subpart
• § 484.305 — Definitions
• § 484.310 — Applicability of the Home Health Value-Based Purchasing (HHVBP) Model
• § 484.315 — Data reporting for measures and evaluation and the public reporting of model data under the Home Health Value-Based Purchasing (HHVBP) Model
• § 484.320 — Calculation of the Total Performance Score
• § 484.325 — Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model
• § 484.330 — Process for determining and applying the value-based payment adjustment under the Home Health Value-Based Purchasing (HHVBP) Model
• § 484.335 — Appeals process for the Home Health Value-Based Purchasing (HHVBP) Model
• § 484.340 — Basis and scope of this subpart
• § 484.345 — Definitions
• § 484.350 — Applicability of the Expanded Home Health Value-Based Purchasing (HHVBP) Model
• § 484.355 — Data reporting for measures and evaluation and the public reporting of model data under the expanded Home Health Value-Based Purchasing (HHVBP) Model
• § 484.358 — HHVBP Measure removal factors
• § 484.360 — Calculation of the Total Performance Score
• § 484.365 — Payments for home health services under the Expanded Home Health Value-Based Purchasing (HHVBP) Model
• § 484.370 — Process for determining and applying the value-based payment adjustment under the Expanded Home Health Value-Based Purchasing (HHVBP) Model
• § 484.375 — Appeals process for the Expanded Home Health Value-Based Purchasing (HHVBP) Model

PART 485

• § 485.50 — Basis and scope
• § 485.51 — Definition
• § 485.54 — Condition of participation: Compliance with State and local laws
• § 485.56 — Condition of participation: Governing body and administration
• § 485.58 — Condition of participation: Comprehensive rehabilitation program
• § 485.60 — Condition of participation: Clinical records
• § 485.62 — Condition of participation: Physical environment
• § 485.64 — [Reserved]
• § 485.66 — Condition of participation: Utilization review plan
• § 485.68 — Condition of participation: Emergency preparedness
• § 485.70 — Personnel qualifications
• § 485.74 — Appeal rights
• § 485.500 — Basis and scope
• § 485.502 — Definitions
• § 485.504 — Basic requirements
• § 485.506 — Designation and certification of REHs
• § 485.508 — Condition of participation: Compliance with Federal, state, and local laws and regulations
• § 485.510 — Condition of participation: Governing body and organizational structure of the REH
• § 485.512 — Condition of participation: Medical staff
• § 485.514 — Condition of participation: Provision of services
• § 485.516 — Condition of participation: Emergency services
• § 485.518 — Condition of participation: Laboratory services
• § 485.520 — Condition of participation: Radiologic services
• § 485.522 — Condition of participation: Pharmaceutical services
• § 485.524 — Condition of participation: Additional outpatient medical and health services
• § 485.526 — Condition of participation: Infection prevention and control and antibiotic stewardship programs
• § 485.528 — Condition of participation: Staffing and staff responsibilities
• § 485.530 — Condition of participation: Nursing services
• § 485.532 — Condition of participation: Discharge planning
• § 485.534 — Condition of participation: Patient's rights
• § 485.536 — Condition of participation: Quality assessment and performance improvement program
• § 485.538 — Condition of participation: Agreements
• § 485.540 — Condition of participation: Medical records
• § 485.542 — Condition of participation: Emergency preparedness
• § 485.544 — Condition of participation: Physical environment
• § 485.546 — Condition of participation: Skilled nursing facility distinct part unit
• § 485.601 — Basis and scope
• § 485.603 — Rural health network
• § 485.604 — Personnel qualifications
• § 485.606 — Designation and certification of CAHs
• § 485.608 — Condition of participation: Compliance with Federal, State, and local laws and regulations
• § 485.610 — Condition of participation: Status and location
• § 485.612 — Condition of participation: Compliance with hospital requirements at the time of application
• § 485.614 — Condition of participation: Patient's rights
• § 485.616 — Condition of participation: Agreements
• § 485.618 — Condition of participation: Emergency services
• § 485.620 — Condition of participation: Number of beds and length of stay
• § 485.623 — Condition of participation: Physical plant and environment
• § 485.625 — Condition of participation: Emergency preparedness
• § 485.627 — Condition of participation: Organizational structure
• § 485.631 — Condition of participation: Staffing and staff responsibilities
• § 485.635 — Condition of participation: Provision of services
• § 485.638 — Conditions of participation: Clinical records
• § 485.639 — Condition of participation: Surgical services
• § 485.640 — Condition of participation: Infection prevention and control and antibiotic stewardship programs
• § 485.641 — Condition of participation: Quality assessment and performance improvement program
• § 485.642 — Condition of participation: Discharge planning
• § 485.643 — Condition of participation: Organ, tissue, and eye procurement
• § 485.645 — Special requirements for CAH providers of long-term care services (“swing-beds”)
• § 485.647 — Condition of participation: psychiatric and rehabilitation distinct part units
• § 485.649 — Condition of participation: Obstetrical services
• § 485.701 — Basis and scope
• § 485.703 — Definitions
• § 485.705 — Personnel qualifications
• § 485.707 — Condition of participation: Compliance with Federal, State, and local laws
• § 485.709 — Condition of participation: Administrative management
• § 485.711 — Condition of participation: Plan of care and physician involvement
• § 485.713 — Condition of participation: Physical therapy services
• § 485.715 — Condition of participation: Speech pathology services
• § 485.717 — Condition of participation: Rehabilitation program
• § 485.719 — Condition of participation: Arrangements for physical therapy and speech pathology services to be performed by other than salaried organization personnel
• § 485.721 — Condition of participation: Clinical records
• § 485.723 — Condition of participation: Physical environment
• § 485.725 — Condition of participation: Infection control
• § 485.727 — Condition of participation: Emergency preparedness
• § 485.729 — Condition of participation: Program evaluation
• § 485.900 — Basis and scope
• § 485.902 — Definitions
• § 485.904 — Condition of participation: Personnel qualifications
• § 485.910 — Condition of participation: Client rights
• § 485.914 — Condition of participation: Admission, initial evaluation, comprehensive assessment, and discharge or transfer of the client
• § 485.916 — Condition of participation: Treatment team, person-centered active treatment plan, and coordination of services
• § 485.917 — Condition of participation: Quality assessment and performance improvement
• § 485.918 — Condition of participation: Organization, governance, administration of services, partial hospitalization services, and intensive outpatient services
• § 485.920 — Condition of participation: Emergency preparedness

PART 486

• § 486.1 — Basis and scope
• § 486.100 — Condition for coverage: Compliance with Federal, State, and local laws and regulations
• § 486.102 — Condition for coverage: Supervision by a qualified physician
• § 486.104 — Condition for coverage: Qualifications, orientation and health of technical personnel
• § 486.106 — Condition for coverage: Referral for service and preservation of records
• § 486.108 — Condition for coverage: Safety standards
• § 486.110 — Condition for coverage: Inspection of equipment
• § 486.301 — Basis and scope
• § 486.302 — Definitions
• § 486.303 — Requirements for certification
• § 486.304 — Requirements for designation
• § 486.306 — OPO service area size designation and documentation requirements
• § 486.308 — Designation of one OPO for each service area
• § 486.309 — Re-certification from August 1, 2006 through July 31, 2010
• § 486.310 — Changes in control or ownership or service area
• § 486.312 — De-certification
• § 486.314 — Appeals
• § 486.316 — Re-certification and competition processes
• § 486.318 — Condition: Outcome measures
• § 486.320 — Condition: Participation in Organ Procurement and Transplantation Network
• § 486.322 — Condition: Relationships with hospitals, critical access hospitals, and tissue banks
• § 486.324 — Condition: Administration and governing body
• § 486.326 — Condition: Human resources
• § 486.328 — Condition: Reporting of data
• § 486.330 — Condition: Information management
• § 486.342 — Condition: Requesting consent
• § 486.344 — Condition: Evaluation and management of potential donors and organ placement and recovery
• § 486.346 — Condition: Organ preparation and transport
• § 486.348 — Condition: Quality assessment and performance improvement (QAPI)
• § 486.360 — Condition for Coverage: Emergency preparedness
• § 486.500 — Basis and scope
• § 486.505 — Definitions
• § 486.520 — Plan of care
• § 486.525 — Required services

PART 488

• § 488.1 — Definitions
• § 488.2 — Statutory basis
• § 488.3 — Conditions of participation, conditions for coverage, conditions for certification and long term care requirements
• § 488.4 — General rules for a CMS-approved accreditation program for providers and suppliers
• § 488.5 — Application and re-application procedures for national accrediting organizations
• § 488.6 — Providers or suppliers that participate in the Medicaid program under a CMS-approved accreditation program
• § 488.7 — Release and use of accreditation surveys
• § 488.8 — Ongoing review of accrediting organizations
• § 488.9 — Validation surveys
• § 488.10 — State survey agency review: Statutory provisions
• § 488.11 — State survey agency functions
• § 488.12 — Effect of survey agency certification
• § 488.13 — Loss of accreditation
• § 488.14 — Effect of QIO review
• § 488.18 — Documentation of findings
• § 488.20 — Periodic review of compliance and approval
• § 488.24 — Certification of noncompliance
• § 488.26 — Determining compliance
• § 488.28 — Providers or suppliers, other than SNFs, NFs, HHAs, and Hospice programs with deficiencies
• § 488.30 — Revisit user fee for revisit surveys
• § 488.52 — [Reserved]
• § 488.54 — Temporary waivers applicable to hospitals
• § 488.56 — Temporary waivers applicable to skilled nursing facilities
• § 488.60 — Special procedures for approving end stage renal disease facilities
• § 488.61 — Special procedures for approval and re-approval of organ transplant programs
• § 488.64 — Remote facility variances for utilization review requirements
• § 488.68 — State Agency responsibilities for OASIS collection and data base requirements
• § 488.70 — Special requirements for rural emergency hospitals (REHs)
• § 488.100 — Long term care survey forms, Part A
• § 488.105 — Long term care survey forms, Part B
• § 488.110 — Procedural guidelines
• § 488.115 — Care guidelines
• § 488.201 — Reconsideration
• § 488.203 — Withdrawal of request for reconsideration
• § 488.205 — Right to informal hearing
• § 488.207 — Informal hearing procedures
• § 488.209 — Hearing officer's findings
• § 488.211 — Final reconsideration determination
• § 488.300 — Statutory basis
• § 488.301 — Definitions
• § 488.303 — State plan requirement
• § 488.305 — Standard surveys
• § 488.307 — Unannounced surveys
• § 488.308 — Survey frequency
• § 488.310 — Extended survey
• § 488.312 — Consistency of survey results
• § 488.314 — Survey teams
• § 488.318 — Inadequate survey performance
• § 488.320 — Sanctions for inadequate survey performance
• § 488.325 — Disclosure of results of surveys and activities
• § 488.330 — Certification of compliance or noncompliance
• § 488.331 — Informal dispute resolution
• § 488.332 — Investigation of complaints of violations and monitoring of compliance
• § 488.334 — Educational programs
• § 488.335 — Action on complaints of resident neglect and abuse, and misappropriation of resident property
• § 488.400 — Statutory basis
• § 488.401 — Definitions
• § 488.402 — General provisions
• § 488.404 — Factors to be considered in selecting remedies
• § 488.406 — Available remedies
• § 488.408 — Selection of remedies
• § 488.410 — Action when there is immediate jeopardy
• § 488.412 — Action when there is no immediate jeopardy
• § 488.414 — Action when there is repeated substandard quality of care
• § 488.415 — Temporary management
• § 488.417 — Denial of payment for all new admissions
• § 488.418 — Secretarial authority to deny all payments
• § 488.422 — State monitoring
• § 488.424 — Directed plan of correction
• § 488.425 — Directed inservice training
• § 488.426 — Transfer of residents, or closure of the facility and transfer of residents
• § 488.430 — Civil money penalties: Basis for imposing penalty
• § 488.431 — Civil money penalties imposed by CMS and independent informal dispute resolution: for SNFS, dually-participating SNF/NFs, and NF-only facilities
• § 488.432 — Civil money penalties imposed by the State: NF-only
• § 488.433 — Civil money penalties: Uses and approval of civil money penalties imposed by CMS
• § 488.434 — Civil money penalties: Notice of penalty
• § 488.436 — Civil money penalties: Waiver of hearing, reduction of penalty amount
• § 488.438 — Civil money penalties: Amount of penalty
• § 488.440 — Civil money penalties: Effective date and duration of penalty
• § 488.442 — Civil money penalties: Due date for payment of penalty
• § 488.444 — Civil money penalties: Settlement of penalties
• § 488.446 — Administrator sanctions: long-term care facility closures
• § 488.447 — Civil Money Penalties imposed for failure to comply with 42 CFR 483.80(g)(1) and (2)
• § 488.450 — Continuation of payments to a facility with deficiencies
• § 488.452 — State and Federal disagreements involving findings not in agreement in non-State operated NFs and dually participating facilities when there is no immediate jeopardy
• § 488.454 — Duration of remedies
• § 488.456 — Termination of provider agreement
• § 488.604 — Termination of Medicare coverage
• § 488.606 — Alternative sanctions
• § 488.608 — Notice of alternative sanction and appeal rights: Termination of coverage
• § 488.610 — Notice of appeal rights: Alternative sanctions
• § 488.700 — Basis and scope
• § 488.705 — Definitions
• § 488.710 — Standard surveys
• § 488.715 — Partial extended surveys
• § 488.720 — Extended surveys
• § 488.725 — Unannounced surveys
• § 488.730 — Survey frequency and content
• § 488.735 — Surveyor qualifications
• § 488.740 — Certification of compliance or noncompliance
• § 488.745 — Informal Dispute Resolution (IDR)
• § 488.800 — Statutory basis
• § 488.805 — Definitions
• § 488.810 — General provisions
• § 488.815 — Factors to be considered in selecting sanctions
• § 488.820 — Available sanctions
• § 488.825 — Action when deficiencies pose immediate jeopardy
• § 488.830 — Action when deficiencies are at the condition-level but do not pose immediate jeopardy
• § 488.835 — Temporary management
• § 488.840 — Suspension of payment for all new patient admissions
• § 488.845 — Civil money penalties
• § 488.850 — Directed plan of correction
• § 488.855 — Directed in-service training
• § 488.860 — Continuation of payments to an HHA with deficiencies
• § 488.865 — Termination of provider agreement
• § 488.1000 — Basis and scope
• § 488.1005 — Definitions
• § 488.1010 — Application and reapplication procedures for national home infusion therapy accrediting organizations
• § 488.1015 — Resubmitting a request for reapproval
• § 488.1020 — Public notice and comment
• § 488.1025 — Release and use of home infusion therapy accreditation surveys
• § 488.1030 — Ongoing review of home infusion therapy accrediting organizations
• § 488.1035 — Ongoing responsibilities of a CMS-approved home infusion therapy accrediting organization
• § 488.1040 — Onsite observations of home infusion therapy accrediting organization operations
• § 488.1045 — Voluntary and involuntary termination
• § 488.1050 — Reconsideration
• § 488.1100 — Basis and scope
• § 488.1105 — Definitions
• § 488.1110 — Hospice program: surveys and hotline
• § 488.1115 — Surveyor qualifications and prohibition of conflicts of interest
• § 488.1120 — Survey teams
• § 488.1125 — Consistency of survey results
• § 488.1130 — Informal dispute resolution (IDR)
• § 488.1135 — Hospice Special Focus Program (SFP)
• § 488.1200 — Statutory basis
• § 488.1205 — Definitions
• § 488.1210 — General provisions
• § 488.1215 — Factors to be considered in selecting remedies
• § 488.1220 — Available remedies
• § 488.1225 — Action when deficiencies pose immediate jeopardy
• § 488.1230 — Action when deficiencies are at the condition-level but do not pose immediate jeopardy
• § 488.1235 — Temporary management
• § 488.1240 — Suspension of payment for all new patient admissions
• § 488.1245 — Civil money penalties
• § 488.1250 — Directed plan of correction
• § 488.1255 — Directed in-service training
• § 488.1260 — Continuation of payments to a hospice program with deficiencies
• § 488.1265 — Termination of provider agreement

PART 489

• § 489.1 — Statutory basis
• § 489.2 — Scope of part
• § 489.3 — Definitions
• § 489.10 — Basic requirements
• § 489.11 — Acceptance of a provider as a participant
• § 489.12 — Decision to deny an agreement
• § 489.13 — Effective date of agreement or approval
• § 489.18 — Change of ownership or leasing: Effect on provider agreement
• § 489.20 — Basic commitments
• § 489.21 — Specific limitations on charges
• § 489.22 — Special provisions applicable to prepayment requirements
• § 489.23 — Specific limitation on charges for services provided to certain enrollees of fee-for-service FEHB plans
• § 489.24 — Special responsibilities of Medicare hospitals in emergency cases
• § 489.25 — Special requirements concerning CHAMPUS and CHAMPVA programs
• § 489.26 — Special requirements concerning veterans
• § 489.27 — Beneficiary notice of discharge or change in status rights
• § 489.28 — Special capitalization requirements for HHAs
• § 489.29 — Special requirements concerning beneficiaries served by the Indian Health Service, Tribal health programs, and urban Indian organization health programs
• § 489.30 — Allowable charges: Deductibles and coinsurance
• § 489.31 — Allowable charges: Blood
• § 489.32 — Allowable charges: Noncovered and partially covered services
• § 489.34 — Allowable charges: Hospitals participating in State reimbursement control systems or demonstration projects
• § 489.35 — Notice to intermediary
• § 489.40 — Definition of incorrect collection
• § 489.41 — Timing and methods of handling
• § 489.42 — Payment of offset amounts to beneficiary or other person
• § 489.52 — Termination by the provider
• § 489.53 — Termination by CMS
• § 489.54 — Termination by the OIG
• § 489.55 — Exceptions to effective date of termination
• § 489.57 — Reinstatement after termination
• § 489.60 — Definitions
• § 489.61 — Basic requirement for surety bonds
• § 489.62 — Requirement waived for Government-operated HHAs
• § 489.63 — Parties to the bond
• § 489.64 — Authorized Surety and exclusion of surety companies
• § 489.65 — Amount of the bond
• § 489.66 — Additional requirements of the surety bond
• § 489.67 — Term and type of bond
• § 489.68 — Effect of failure to obtain, maintain, and timely file a surety bond
• § 489.69 — Evidence of compliance
• § 489.70 — Effect of payment by the Surety
• § 489.71 — Surety's standing to appeal Medicare determinations
• § 489.72 — Effect of review reversing determination
• § 489.73 — Effect of conditions of payment
• § 489.74 — Incorporation into existing provider agreements
• § 489.100 — Definition
• § 489.102 — Requirements for providers
• § 489.104 — Effective dates

PART 491

• § 491.1 — Purpose and scope
• § 491.2 — Definitions
• § 491.3 — Certification procedures
• § 491.4 — Compliance with Federal, State and local laws
• § 491.5 — Location of clinic
• § 491.6 — Physical plant and environment
• § 491.7 — Organizational structure
• § 491.8 — Staffing and staff responsibilities
• § 491.9 — Provision of services
• § 491.10 — Patient health records
• § 491.11 — Program evaluation
• § 491.12 — Emergency preparedness

PART 493

• § 493.1 — Basis and scope
• § 493.2 — Definitions
• § 493.3 — Applicability
• § 493.5 — Categories of tests by complexity
• § 493.15 — Laboratories performing waived tests
• § 493.17 — Test categorization
• § 493.19 — Provider-performed microscopy (PPM) procedures
• § 493.20 — Laboratories performing tests of moderate complexity
• § 493.25 — Laboratories performing tests of high complexity
• § 493.35 — Application for a certificate of waiver
• § 493.37 — Requirements for a certificate of waiver
• § 493.39 — Notification requirements for laboratories issued a certificate of waiver
• § 493.41 — Condition: Reporting of SARS-CoV-2 test results
• § 493.43 — Application for registration certificate, certificate for provider-performed microscopy (PPM) procedures, and certificate of compliance
• § 493.45 — Requirements for a registration certificate
• § 493.47 — Requirements for a certificate for provider-performed microscopy (PPM) procedures
• § 493.49 — Requirements for a certificate of compliance
• § 493.51 — Notification requirements for laboratories issued a certificate of compliance
• § 493.53 — Notification requirements for laboratories issued a certificate for provider-performed microscopy (PPM) procedures
• § 493.55 — Application for registration certificate and certificate of accreditation
• § 493.57 — Requirements for a registration certificate
• § 493.61 — Requirements for a certificate of accreditation
• § 493.63 — Notification requirements for laboratories issued a certificate of accreditation
• § 493.551 — General requirements for laboratories
• § 493.553 — Approval process (application and reapplication) for accreditation organizations and State licensure programs
• § 493.555 — Federal review of laboratory requirements
• § 493.557 — Additional submission requirements
• § 493.559 — Publication of approval of deeming authority or CLIA exemption
• § 493.561 — Denial of application or reapplication
• § 493.563 — Validation inspections—Basis and focus
• § 493.565 — Selection for validation inspection—laboratory responsibilities
• § 493.567 — Refusal to cooperate with validation inspection
• § 493.569 — Consequences of a finding of noncompliance as a result of a validation inspection
• § 493.571 — Disclosure of accreditation, State and CMS validation inspection results
• § 493.573 — Continuing Federal oversight of private nonprofit accreditation organizations and approved State licensure programs
• § 493.575 — Removal of deeming authority or CLIA exemption and final determination review
• § 493.602 — Scope of subpart
• § 493.606 — Applicability of subpart
• § 493.638 — Certificate fees
• § 493.639 — Fees for revised and replacement certificates
• § 493.643 — Additional fees applicable to laboratories issued a certificate of compliance
• § 493.645 — Additional fees applicable to laboratories issued a certificate of accreditation, certificate of waiver, or certificate for PPM procedures
• § 493.649 — Additional fees applicable to approved State laboratory programs
• § 493.655 — Payment of fees
• § 493.680 — Methodology for determining the biennial fee increase
• § 493.801 — Condition: Enrollment and testing of samples
• § 493.803 — Condition: Successful participation
• § 493.807 — Condition: Reinstatement of laboratories performing nonwaived testing
• § 493.821 — Condition: Microbiology
• § 493.823 — Standard; Bacteriology
• § 493.825 — Standard; Mycobacteriology
• § 493.827 — Standard; Mycology
• § 493.829 — Standard; Parasitology
• § 493.831 — Standard; Virology
• § 493.833 — Condition: Diagnostic immunology
• § 493.835 — Standard; Syphilis serology
• § 493.837 — Standard; General immunology
• § 493.839 — Condition: Chemistry
• § 493.841 — Standard; Routine chemistry
• § 493.843 — Standard; Endocrinology
• § 493.845 — Standard; Toxicology
• § 493.849 — Condition: Hematology
• § 493.851 — Standard; Hematology
• § 493.853 — Condition: Pathology
• § 493.855 — Standard; Cytology: gynecologic examinations
• § 493.857 — Condition: Immunohematology
• § 493.859 — Standard; ABO group and D (Rho) typing
• § 493.861 — Standard; Unexpected antibody detection
• § 493.863 — Standard; Compatibility testing
• § 493.865 — Standard; Antibody identification
• § 493.901 — Approval of proficiency testing programs
• § 493.903 — Administrative responsibilities
• § 493.905 — Nonapproved proficiency testing programs
• § 493.909 — Microbiology
• § 493.911 — Bacteriology
• § 493.913 — Mycobacteriology
• § 493.915 — Mycology
• § 493.917 — Parasitology
• § 493.919 — Virology
• § 493.921 — Diagnostic immunology
• § 493.923 — Syphilis serology
• § 493.927 — General immunology
• § 493.929 — Chemistry
• § 493.931 — Routine chemistry
• § 493.933 — Endocrinology
• § 493.937 — Toxicology
• § 493.941 — Hematology (including routine hematology and coagulation)
• § 493.945 — Cytology; gynecologic examinations
• § 493.959 — Immunohematology
• § 493.1100 — Condition: Facility administration
• § 493.1101 — Standard: Facilities
• § 493.1103 — Standard: Requirements for transfusion services
• § 493.1105 — Standard: Retention requirements
• § 493.1200 — Introduction
• § 493.1201 — Condition: Bacteriology
• § 493.1202 — Condition: Mycobacteriology
• § 493.1203 — Condition: Mycology
• § 493.1204 — Condition: Parasitology
• § 493.1205 — Condition: Virology
• § 493.1207 — Condition: Syphilis serology
• § 493.1208 — Condition: General immunology
• § 493.1210 — Condition: Routine chemistry
• § 493.1211 — Condition: Urinalysis
• § 493.1212 — Condition: Endocrinology
• § 493.1213 — Condition: Toxicology
• § 493.1215 — Condition: Hematology
• § 493.1217 — Condition: Immunohematology
• § 493.1219 — Condition: Histopathology
• § 493.1220 — Condition: Oral pathology
• § 493.1221 — Condition: Cytology
• § 493.1225 — Condition: Clinical cytogenetics
• § 493.1226 — Condition: Radiobioassay
• § 493.1227 — Condition: Histocompatibility
• § 493.1230 — Condition: General laboratory systems
• § 493.1231 — Standard: Confidentiality of patient information
• § 493.1232 — Standard: Specimen identification and integrity
• § 493.1233 — Standard: Complaint investigations
• § 493.1234 — Standard: Communications
• § 493.1235 — Standard: Personnel competency assessment policies
• § 493.1236 — Standard: Evaluation of proficiency testing performance
• § 493.1239 — Standard: General laboratory systems quality assessment
• § 493.1240 — Condition: Preanalytic systems
• § 493.1241 — Standard: Test request
• § 493.1242 — Standard: Specimen submission, handling, and referral
• § 493.1249 — Standard: Preanalytic systems quality assessment
• § 493.1250 — Condition: Analytic systems
• § 493.1251 — Standard: Procedure manual
• § 493.1252 — Standard: Test systems, equipment, instruments, reagents, materials, and supplies
• § 493.1253 — Standard: Establishment and verification of performance specifications
• § 493.1254 — Standard: Maintenance and function checks
• § 493.1255 — Standard: Calibration and calibration verification procedures
• § 493.1256 — Standard: Control procedures
• § 493.1261 — Standard: Bacteriology
• § 493.1262 — Standard: Mycobacteriology
• § 493.1263 — Standard: Mycology
• § 493.1264 — Standard: Parasitology
• § 493.1265 — Standard: Virology
• § 493.1267 — Standard: Routine chemistry
• § 493.1269 — Standard: Hematology
• § 493.1271 — Standard: Immunohematology
• § 493.1273 — Standard: Histopathology
• § 493.1274 — Standard: Cytology
• § 493.1276 — Standard: Clinical cytogenetics
• § 493.1278 — Standard: Histocompatibility
• § 493.1281 — Standard: Comparison of test results
• § 493.1282 — Standard: Corrective actions
• § 493.1283 — Standard: Test records
• § 493.1289 — Standard: Analytic systems quality assessment
• § 493.1290 — Condition: Postanalytic systems
• § 493.1291 — Standard: Test report
• § 493.1299 — Standard: Postanalytic systems quality assessment
• § 493.1351 — General
• § 493.1353 — Scope
• § 493.1355 — Condition: Laboratories performing PPM procedures; laboratory director
• § 493.1357 — Standard; laboratory director qualifications
• § 493.1359 — Standard; PPM laboratory director responsibilities
• § 493.1361 — Condition: Laboratories performing PPM procedures; testing personnel
• § 493.1363 — Standard: PPM testing personnel qualifications
• § 493.1365 — Standard; PPM testing personnel responsibilities
• § 493.1403 — Condition: Laboratories performing moderate complexity testing; laboratory director
• § 493.1405 — Standard; Laboratory director qualifications
• § 493.1407 — Standard; Laboratory director responsibilities
• § 493.1409 — Condition: Laboratories performing moderate complexity testing; technical consultant
• § 493.1411 — Standard; Technical consultant qualifications
• § 493.1413 — Standard; Technical consultant responsibilities
• § 493.1415 — Condition: Laboratories performing moderate complexity testing; clinical consultant
• § 493.1417 — Standard; Clinical consultant qualifications
• § 493.1419 — Standard; Clinical consultant responsibilities
• § 493.1421 — Condition: Laboratories performing moderate complexity testing; testing personnel
• § 493.1423 — Standard; Testing personnel qualifications
• § 493.1425 — Standard; Testing personnel responsibilities
• § 493.1441 — Condition: Laboratories performing high complexity testing; laboratory director
• § 493.1443 — Standard; Laboratory director qualifications
• § 493.1445 — Standard; Laboratory director responsibilities
• § 493.1447 — Condition: Laboratories performing high complexity testing; technical supervisor
• § 493.1449 — Standard; Technical supervisor qualifications
• § 493.1451 — Standard: Technical supervisor responsibilities
• § 493.1453 — Condition: Laboratories performing high complexity testing; clinical consultant
• § 493.1455 — Standard; Clinical consultant qualifications
• § 493.1457 — Standard; Clinical consultant responsibilities
• § 493.1459 — Condition: Laboratories performing high complexity testing; general supervisor
• § 493.1461 — Standard: General supervisor qualifications
• § 493.1463 — Standard: General supervisor responsibilities
• § 493.1467 — Condition: Laboratories performing high complexity testing; cytology general supervisor
• § 493.1469 — Standard: Cytology general supervisor qualifications
• § 493.1471 — Standard: Cytology general supervisor responsibilities
• § 493.1481 — Condition: Laboratories performing high complexity testing; cytotechnologist
• § 493.1483 — Standard: Cytotechnologist qualifications
• § 493.1485 — Standard; Cytotechnologist responsibilities
• § 493.1487 — Condition: Laboratories performing high complexity testing; testing personnel
• § 493.1489 — Standard; Testing personnel qualifications
• § 493.1495 — Standard; Testing personnel responsibilities
• § 493.1771 — Condition: Inspection requirements applicable to all CLIA-certified and CLIA-exempt laboratories
• § 493.1773 — Standard: Basic inspection requirements for all laboratories issued a CLIA certificate and CLIA-exempt laboratories
• § 493.1775 — Standard: Inspection of laboratories issued a certificate of waiver or a certificate for provider-performed microscopy procedures
• § 493.1777 — Standard: Inspection of laboratories that have requested or have been issued a certificate of compliance
• § 493.1780 — Standard: Inspection of CLIA-exempt laboratories or laboratories requesting or issued a certificate of accreditation
• § 493.1800 — Basis and scope
• § 493.1804 — General considerations
• § 493.1806 — Available sanctions: All laboratories
• § 493.1807 — Additional sanctions: Laboratories that participate in Medicare
• § 493.1808 — Adverse action on any type of CLIA certificate: Effect on Medicare approval
• § 493.1809 — Limitation on Medicaid payment
• § 493.1810 — Imposition and lifting of alternative sanctions
• § 493.1812 — Action when deficiencies pose immediate jeopardy
• § 493.1814 — Action when deficiencies are at the condition level but do not pose immediate jeopardy
• § 493.1816 — Action when deficiencies are not at the condition level
• § 493.1820 — Ensuring timely correction of deficiencies
• § 493.1826 — Suspension of part of Medicare payments
• § 493.1828 — Suspension of all Medicare payments
• § 493.1832 — Directed plan of correction and directed portion of a plan of correction
• § 493.1834 — Civil money penalty
• § 493.1836 — State onsite monitoring
• § 493.1838 — Training and technical assistance for unsuccessful participation in proficiency testing
• § 493.1840 — Suspension, limitation, or revocation of any type of CLIA certificate
• § 493.1842 — Cancellation of Medicare approval
• § 493.1844 — Appeals procedures
• § 493.1846 — Civil action
• § 493.1850 — Laboratory registry
• § 493.2001 — Establishment and function of the Clinical Laboratory Improvement Advisory Committee

PART 494

• § 494.1 — Basis and scope
• § 494.10 — Definitions
• § 494.20 — Condition: Compliance with Federal, State, and local laws and regulations
• § 494.30 — Condition: Infection control
• § 494.40 — Condition: Water and dialysate quality
• § 494.50 — Condition: Reuse of hemodialyzers and bloodlines
• § 494.60 — Condition: Physical environment
• § 494.62 — Condition of participation: Emergency preparedness
• § 494.70 — Condition: Patients' rights
• § 494.80 — Condition: Patient assessment
• § 494.90 — Condition: Patient plan of care
• § 494.100 — Condition: Care at home
• § 494.110 — Condition: Quality assessment and performance improvement
• § 494.120 — Condition: Special purpose renal dialysis facilities
• § 494.130 — Condition: Laboratory services
• § 494.140 — Condition: Personnel qualifications
• § 494.150 — Condition: Responsibilities of the medical director
• § 494.160 — [Reserved]
• § 494.170 — Condition: Medical records
• § 494.180 — Condition: Governance

PART 495

• § 495.2 — Basis and purpose
• § 495.4 — Definitions
• § 495.5 — Requirements for EPs seeking to reverse a hospital-based determination under § 495.4
• § 495.20 — Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs before 2015
• § 495.22 — Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs for 2015 through 2018
• § 495.24 — Stage 3 meaningful use objectives and measures for EPs, eligible hospitals and CAHs for 2019 and subsequent years
• § 495.40 — Demonstration of meaningful use criteria
• § 495.60 — Participation requirements for EPs, eligible hospitals, and CAHs
• § 495.100 — Definitions
• § 495.102 — Incentive payments to EPs
• § 495.104 — Incentive payments to eligible hospitals
• § 495.106 — Incentive payments to CAHs
• § 495.108 — Posting of required information
• § 495.110 — Preclusion on administrative and judicial review
• § 495.200 — Definitions
• § 495.202 — Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals
• § 495.204 — Incentive payments to qualifying MA organizations for qualifying MA-EPs and qualifying MA-affiliated eligible hospitals
• § 495.206 — Timeframe for payment to qualifying MA organizations
• § 495.208 — Avoiding duplicate payment
• § 495.210 — Meaningful EHR user attestation
• § 495.211 — Payment adjustments effective for 2015 and subsequent MA payment years with respect to MA EPs and MA-affiliated eligible hospitals
• § 495.212 — Limitation on review
• § 495.300 — Basis and purpose
• § 495.302 — Definitions
• § 495.304 — Medicaid provider scope and eligibility
• § 495.306 — Establishing patient volume
• § 495.308 — Net average allowable costs as the basis for determining the incentive payment
• § 495.310 — Medicaid provider incentive payments
• § 495.312 — Process for payments
• § 495.314 — Activities required to receive an incentive payment
• § 495.316 — State monitoring and reporting regarding activities required to receive an incentive payment
• § 495.318 — State responsibilities for receiving FFP
• § 495.320 — FFP for payments to Medicaid providers
• § 495.322 — FFP for reasonable administrative expenses
• § 495.324 — Prior approval conditions
• § 495.326 — Disallowance of FFP
• § 495.328 — Request for reconsideration of adverse determination
• § 495.330 — Termination of FFP for failure to provide access to information
• § 495.332 — State Medicaid health information technology (HIT) plan requirements
• § 495.334 — [Reserved]
• § 495.336 — Health information technology planning advance planning document requirements (HIT PAPD)
• § 495.338 — Health information technology implementation advance planning document requirements (HIT IAPD)
• § 495.340 — As-needed HIT PAPD update and as-needed HIT IAPD update requirements
• § 495.342 — Annual HIT IAPD requirements
• § 495.344 — Approval of the State Medicaid HIT plan, the HIT PAPD and update, the HIT IAPD and update, and the annual HIT IAPD
• § 495.346 — Access to systems and records
• § 495.348 — Procurement standards
• § 495.350 — State Medicaid agency attestations
• § 495.352 — Reporting requirements
• § 495.354 — Rules for charging equipment
• § 495.356 — Nondiscrimination requirements
• § 495.358 — Cost allocation plans
• § 495.360 — Software and ownership rights
• § 495.362 — Retroactive approval of FFP with an effective date of February 18, 2009
• § 495.364 — Review and assessment of administrative activities and expenses of Medicaid provider health information technology adoption and operation
• § 495.366 — Financial oversight and monitoring of expenditures
• § 495.368 — Combating fraud and abuse
• § 495.370 — Appeals process for a Medicaid provider receiving electronic health record incentive payments

PART 498

• § 498.1 — Statutory basis
• § 498.2 — Definitions
• § 498.3 — Scope and applicability
• § 498.4 — NFs subject to appeals process in part 498
• § 498.5 — Appeal rights
• § 498.10 — Appointment of representatives
• § 498.11 — Authority of representatives
• § 498.13 — Fees for services of representatives
• § 498.15 — Charge for transcripts
• § 498.17 — Filing of briefs with the ALJ or Departmental Appeals Board, and opportunity for rebuttal
• § 498.20 — Notice and effect of initial determinations
• § 498.22 — Reconsideration
• § 498.23 — Withdrawal of request for reconsideration
• § 498.24 — Reconsidered determination
• § 498.25 — Notice and effect of reconsidered determination
• § 498.30 — Limitation on reopening
• § 498.32 — Notice and effect of reopening and revision
• § 498.40 — Request for hearing
• § 498.42 — Parties to the hearing
• § 498.44 — Designation of hearing official
• § 498.45 — Disqualification of Administrative Law Judge
• § 498.47 — Prehearing conference
• § 498.48 — Notice of prehearing conference
• § 498.49 — Conduct of prehearing conference
• § 498.50 — Record, order, and effect of prehearing conference
• § 498.52 — Time and place of hearing
• § 498.53 — Change in time and place of hearing
• § 498.54 — Joint hearings
• § 498.56 — Hearing on new issues
• § 498.58 — Subpoenas
• § 498.60 — Conduct of hearing
• § 498.61 — Evidence
• § 498.62 — Witnesses
• § 498.63 — Oral and written summation
• § 498.64 — Record of hearing
• § 498.66 — Waiver of right to appear and present evidence
• § 498.68 — Dismissal of request for hearing
• § 498.69 — Dismissal for abandonment
• § 498.70 — Dismissal for cause
• § 498.71 — Notice and effect of dismissal and right to request review
• § 498.72 — Vacating a dismissal of request for hearing
• § 498.74 — Administrative Law Judge's decision
• § 498.76 — Removal of hearing to Departmental Appeals Board
• § 498.78 — Remand by the Administrative Law Judge
• § 498.79 — Timeframes for deciding an enrollment appeal before an ALJ
• § 498.80 — Right to request Departmental Appeals Board review of Administrative Law Judge's decision or dismissal
• § 498.82 — Request for Departmental Appeals Board review
• § 498.83 — Departmental Appeals Board action on request for review
• § 498.85 — Procedures before the Departmental Appeals Board on review
• § 498.86 — Evidence admissible on review
• § 498.88 — Decision or remand by the Departmental Appeals Board
• § 498.90 — Effect of Departmental Appeals Board decision
• § 498.95 — Extension of time for seeking judicial review
• § 498.100 — Basis, timing, and authority for reopening an ALJ or Board decision
• § 498.102 — Revision of reopened decision
• § 498.103 — Notice and effect of revised decision

PART 505

• § 505.1 — Basis and scope
• § 505.3 — Definitions
• § 505.5 — Loan criteria
• § 505.7 — Terms of the loan
• § 505.9 — State and local permits
• § 505.11 — Loan application requirements and procedures
• § 505.13 — Conditions for loan forgiveness
• § 505.15 — Plan criteria for meeting the conditions for loan forgiveness
• § 505.17 — Reporting requirements for meeting the conditions for loan forgiveness
• § 505.19 — Approval or denial of loan forgiveness

PART 510

• § 510.1 — Basis and scope
• § 510.2 — Definitions
• § 510.100 — Episodes being tested
• § 510.105 — Geographic areas
• § 510.110 — Access to records and retention
• § 510.115 — Voluntary participation election
• § 510.120 — CJR participant hospital CEHRT track requirements
• § 510.200 — Time periods, included and excluded services, and attribution
• § 510.205 — Beneficiary inclusion criteria
• § 510.210 — Determination of the episode
• § 510.300 — Determination of episode quality-adjusted target prices
• § 510.301 — Determination of reconciliation target prices
• § 510.305 — Determination of the NPRA and reconciliation process
• § 510.310 — Appeals process
• § 510.315 — Composite quality scores for determining reconciliation payment eligibility and quality incentive payments
• § 510.320 — Treatment of incentive programs or add-on payments under existing Medicare payment systems
• § 510.325 — Allocation of payments for services that straddle the episode
• § 510.400 — Quality measures and reporting
• § 510.405 — Beneficiary choice and beneficiary notification
• § 510.410 — Compliance enforcement
• § 510.500 — Sharing arrangements under the CJR model
• § 510.505 — Distribution arrangements
• § 510.506 — Downstream distribution arrangements
• § 510.510 — Enforcement authority
• § 510.515 — Beneficiary incentives under the CJR model
• § 510.600 — Waiver of direct supervision requirement for certain post-discharge home visits
• § 510.605 — Waiver of certain telehealth requirements
• § 510.610 — Waiver of SNF 3-day rule
• § 510.615 — Waiver of certain post-operative billing restrictions
• § 510.620 — Waiver of deductible and coinsurance that otherwise apply to reconciliation payments or repayments
• § 510.900 — Termination of the CJR model

PART 512

• § 512.100 — Basis and scope
• § 512.110 — Definitions
• § 512.120 — Beneficiary protections
• § 512.130 — Cooperation in model evaluation and monitoring
• § 512.135 — Audits and record retention
• § 512.140 — Rights in data and intellectual property
• § 512.150 — Monitoring and compliance
• § 512.160 — Remedial action
• § 512.165 — Innovation center model termination by CMS
• § 512.170 — Limitations on review
• § 512.180 — Miscellaneous provisions on bankruptcy and other notifications
• § 512.190 — Reconsideration review process
• § 512.200 — Basis and scope of subpart
• § 512.205 — Definitions
• § 512.210 — RO participants and geographic areas
• § 512.215 — Beneficiary population
• § 512.217 — Identification of individual practitioners
• § 512.220 — RO participant compliance with RO Model requirements
• § 512.225 — Beneficiary notification
• § 512.230 — Criteria for determining cancer types
• § 512.235 — Included RT services
• § 512.240 — Included modalities
• § 512.245 — Included RO episodes
• § 512.250 — Determination of national base rates
• § 512.255 — Determination of participant-specific professional episode payment and participant-specific technical episode payment amounts
• § 512.260 — Billing
• § 512.265 — Payment
• § 512.270 — Treatment of add-on payments under existing Medicare payment systems
• § 512.275 — Quality measures, clinical data, and reporting
• § 512.280 — RO Model Medicare program waivers
• § 512.285 — Reconciliation process
• § 512.290 — Timely error notice and reconsideration review process
• § 512.292 — Overlap with other models tested under Section 1115A and CMS programs
• § 512.294 — Extreme and uncontrollable circumstances
• § 512.300 — Basis and scope
• § 512.310 — Definitions
• § 512.320 — Duration
• § 512.325 — Participant selection and geographic areas
• § 512.330 — Beneficiary notification
• § 512.340 — Payments subject to the Facility HDPA
• § 512.345 — Payments subject to the Clinician HDPA
• § 512.350 — Schedule of home dialysis payment adjustments
• § 512.355 — Schedule of performance assessment and performance payment adjustment
• § 512.360 — Beneficiary population and attribution
• § 512.365 — Performance assessment
• § 512.370 — Benchmarking and scoring
• § 512.375 — Payments subject to adjustment
• § 512.380 — PPA Amounts and schedules
• § 512.385 — PPA exclusions
• § 512.390 — Notification, data sharing, and targeted review
• § 512.395 — Quality measures
• § 512.397 — ETC Model Medicare program waivers and additional flexibilities
• § 512.400 — Basis and scope
• § 512.402 — Definitions
• § 512.412 — Participant eligibility and selection
• § 512.414 — Patient population
• § 512.422 — Overview of performance assessment and scoring
• § 512.424 — Achievement domain
• § 512.426 — Efficiency domain
• § 512.428 — Quality domain
• § 512.430 — Upside risk payment, downside risk payment, and neutral zone
• § 512.434 — Targeted review
• § 512.436 — Extreme and uncontrollable circumstances
• § 512.440 — Data sharing
• § 512.442 — Transparency requirements
• § 512.446 — Health equity plans
• § 512.450 — Required beneficiary notifications
• § 512.452 — Financial sharing arrangements and attributed patient engagement incentives
• § 512.454 — Distribution arrangements
• § 512.455 — Enforcement authority
• § 512.456 — Beneficiary incentive: Part B and Part D immunosuppressive drug cost sharing support
• § 512.458 — Attributed patient engagement incentives
• § 512.459 — Application of the CMS-sponsored model arrangements and patient incentives safe harbor
• § 512.460 — Audit rights and records retention
• § 512.462 — Compliance and monitoring
• § 512.464 — Remedial action
• § 512.466 — Termination
• § 512.468 — Bankruptcy and other notifications
• § 512.470 — Waivers
• § 512.500 — Basis and scope of subpart
• § 512.505 — Definitions
• § 512.508 — Mandatory participation
• § 512.510 — Voluntary opt-in participation
• § 512.515 — Geographic areas
• § 512.520 — Participation tracks
• § 512.522 — APM options
• § 512.525 — Episodes
• § 512.535 — Beneficiary inclusion criteria
• § 512.537 — Determination of the episode
• § 512.540 — Determination of preliminary target prices
• § 512.545 — Determination of reconciliation target prices
• § 512.547 — Quality measures, composite quality score, and display of quality measures
• § 512.550 — Reconciliation process and determination of the reconciliation payment or repayment amount
• § 512.552 — Treatment of incentive programs or add-on payments under existing Medicare payment systems
• § 512.555 — Proration of payments for services that extend beyond an episode
• § 512.560 — Appeals process
• § 512.561 — Reconsideration review processes
• § 512.562 — Data sharing with TEAM participants
• § 512.563 — Health data reporting
• § 512.564 — Referral to primary care services
• § 512.565 — Sharing arrangements
• § 512.568 — Distribution arrangements
• § 512.570 — Downstream distribution arrangements
• § 512.575 — TEAM beneficiary incentives
• § 512.576 — Application of the CMS-sponsored model arrangements and patient incentives safe harbor
• § 512.580 — TEAM Medicare Program Waivers
• § 512.582 — Beneficiary protections
• § 512.584 — Cooperation in model evaluation and monitoring
• § 512.586 — Audits and record retention
• § 512.588 — Rights in data and intellectual property
• § 512.590 — Monitoring and compliance
• § 512.592 — Remedial action
• § 512.594 — Limitations on review
• § 512.595 — Bankruptcy and other notifications
• § 512.596 — Termination of TEAM or TEAM participant from model by CMS
• § 512.700 — Basis and scope of subpart
• § 512.705 — Definitions
• § 512.710 — Participant eligibility and selection
• § 512.715 — Overview of performance assessment
• § 512.720 — Data submission requirements
• § 512.725 — Quality ASM performance category
• § 512.730 — Cost ASM performance category
• § 512.735 — Improvement activities ASM performance category
• § 512.740 — Promoting Interoperability ASM performance category
• § 512.745 — Final scoring
• § 512.750 — Payment adjustment
• § 512.755 — Timely error notice process
• § 512.760 — Data sharing with ASM participants
• § 512.765 — Application of the CMS-sponsored model arrangements and patient incentives safe harbor
• § 512.770 — ASM beneficiary incentives
• § 512.771 — Collaborative care arrangements
• § 512.775 — Medicare program waivers
• § 512.780 — Extreme and uncontrollable circumstances

PART 600

• § 600.1 — Scope
• § 600.5 — Definitions and use of terms
• § 600.100 — Program description
• § 600.105 — Basis, scope, and applicability of subpart B
• § 600.110 — BHP Blueprint
• § 600.115 — Development and submission of the BHP Blueprint
• § 600.120 — Certification of a BHP Blueprint
• § 600.125 — Revisions to a certified BHP Blueprint
• § 600.130 — Withdrawal of a BHP Blueprint prior to implementation
• § 600.135 — Notice and timing of HHS action on an initial BHP Blueprint submission
• § 600.140 — State termination of a BHP
• § 600.142 — HHS withdrawal of certification and termination of a BHP
• § 600.145 — State program administration and operation
• § 600.150 — Enrollment assistance and information requirements
• § 600.155 — Tribal consultation
• § 600.160 — Protections for American Indian and Alaska Natives
• § 600.165 — Nondiscrimination standards
• § 600.170 — Annual report content and timing
• § 600.200 — Federal program compliance reviews and audits
• § 600.300 — Basis, scope, and applicability
• § 600.305 — Eligible individuals
• § 600.310 — Application
• § 600.315 — Certified application counselors
• § 600.320 — Determination of eligibility for and enrollment in a standard health plan
• § 600.330 — Coordination with other insurance affordability programs
• § 600.335 — Appeals
• § 600.340 — Periodic redetermination and renewal of BHP eligibility
• § 600.345 — Eligibility verification
• § 600.350 — Privacy and security of information
• § 600.400 — Basis, scope, and applicability
• § 600.405 — Standard health plan coverage
• § 600.410 — Competitive contracting process
• § 600.415 — Contracting qualifications and requirements
• § 600.420 — Enhanced availability of standard health plans
• § 600.425 — Coordination with other insurance affordability programs
• § 600.500 — Basis, scope, and applicability
• § 600.505 — Premiums
• § 600.510 — Cost-sharing
• § 600.515 — Public schedule of enrollee premium and cost sharing
• § 600.520 — General cost-sharing protections
• § 600.525 — Disenrollment procedures and consequences for nonpayment of premiums
• § 600.600 — Basis, scope, and applicability
• § 600.605 — BHP payment methodology
• § 600.610 — Secretarial determination of BHP payment amount
• § 600.615 — Deposit of Federal BHP payment
• § 600.700 — Basis, scope, and applicability
• § 600.705 — BHP trust fund
• § 600.710 — Fiscal policies and accountability
• § 600.715 — Corrective action, restitution, and disallowance of questioned BHP transactions

PART 1000

• § 1000.10 — General definitions

PART 1001

• § 1001.1 — Scope and purpose
• § 1001.2 — Definitions
• § 1001.101 — Basis for liability
• § 1001.102 — Length of exclusion
• § 1001.201 — Conviction relating to program or health care fraud
• § 1001.301 — Conviction relating to obstruction of an investigation or audit
• § 1001.401 — Conviction relating to controlled substances
• § 1001.501 — License revocation or suspension
• § 1001.601 — Exclusion or suspension under a Federal or State health care program
• § 1001.701 — Excessive claims or furnishing of unnecessary or substandard items and services
• § 1001.801 — Failure of HMOs and CMPs to furnish medically necessary items and services
• § 1001.901 — False or improper claims
• § 1001.951 — Fraud and kickbacks and other prohibited activities
• § 1001.952 — Exceptions
• § 1001.1001 — Exclusion of entities owned or controlled by a sanctioned person
• § 1001.1101 — Failure to disclose certain information
• § 1001.1201 — Failure to provide payment information
• § 1001.1301 — Failure to grant immediate access
• § 1001.1401 — Violations of PPS corrective action
• § 1001.1501 — Default of health education loan or scholarship obligations
• § 1001.1551 — Exclusion of individuals with ownership or control interest in sanctioned entities
• § 1001.1552 — Making false statements or misrepresentation of material facts
• § 1001.1601 — Violations of the limitations on physician charges
• § 1001.1701 — Billing for services of assistant at surgery during cataract operations
• § 1001.1801 — Waivers of exclusions
• § 1001.1901 — Scope and effect of exclusion
• § 1001.2001 — Notice of intent to exclude
• § 1001.2002 — Notice of exclusion
• § 1001.2003 — Notice of proposal to exclude
• § 1001.2004 — Notice to State agencies
• § 1001.2005 — Notice to State licensing agencies
• § 1001.2006 — Notice to others regarding exclusion
• § 1001.2007 — Appeal of exclusions
• § 1001.3001 — Timing and method of request for reinstatement
• § 1001.3002 — Basis for reinstatement
• § 1001.3003 — Approval of request for reinstatement
• § 1001.3004 — Denial of request for reinstatement
• § 1001.3005 — Withdrawal of exclusion for reversed or vacated decisions

PART 1002

• § 1002.1 — Basis and scope
• § 1002.2 — Other applicable regulations
• § 1002.3 — General authority
• § 1002.4 — Disclosure by providers and State Medicaid agencies
• § 1002.5 — State plan requirement
• § 1002.6 — Payment prohibitions
• § 1002.203 — State exclusion of certain managed care entities
• § 1002.210 — General authority
• § 1002.211 — [Reserved]
• § 1002.212 — State agency notifications
• § 1002.213 — Appeals of exclusions
• § 1002.214 — Basis for reinstatement after State agency-initiated exclusion
• § 1002.215 — Action on request for reinstatement
• § 1002.230 — Notification of State or local convictions of crimes against Medicaid

PART 1003

• § 1003.100 — Basis and purpose
• § 1003.110 — Definitions
• § 1003.120 — Liability for penalties and assessments
• § 1003.130 — Assessments
• § 1003.140 — Determinations regarding the amount of penalties and assessments and the period of exclusion
• § 1003.150 — Delegation of authority
• § 1003.160 — Waiver of exclusion
• § 1003.200 — Basis for civil money penalties, assessments, and exclusions
• § 1003.210 — Amount of penalties and assessments
• § 1003.220 — Determinations regarding the amount of penalties and assessments and the period of exclusion
• § 1003.300 — Basis for civil money penalties, assessments, and exclusions
• § 1003.310 — Amount of penalties and assessments
• § 1003.320 — Determinations regarding the amount of penalties and assessments and the period of exclusion
• § 1003.400 — Basis for civil money penalties and assessments
• § 1003.410 — Amount of penalties and assessments for Contracting Organization
• § 1003.420 — Determinations regarding the amount of penalties and assessments
• § 1003.500 — Basis for civil money penalties and exclusions
• § 1003.510 — Amount of penalties
• § 1003.520 — Determinations regarding the amount of penalties and the period of exclusion
• § 1003.600 — Basis for civil money penalties
• § 1003.610 — Amount of penalties
• § 1003.620 — Determinations regarding the amount of penalties
• § 1003.700 — Basis for civil money penalties, assessments, and exclusions
• § 1003.710 — Amount of penalties and assessments
• § 1003.720 — Determinations regarding the amount of penalties and assessments and period of exclusion
• § 1003.800 — Basis for civil money penalties
• § 1003.810 — Amount of penalties
• § 1003.820 — Determinations regarding the amount of penalties
• § 1003.900 — Basis for civil money penalties
• § 1003.910 — Amount of penalties
• § 1003.920 — Determinations regarding the amount of penalties
• § 1003.1000 — Basis for civil money penalties, assessments, and exclusions
• § 1003.1010 — Amount of penalties and assessments
• § 1003.1020 — Determinations regarding the amount of penalties and assessments and the period of exclusion
• § 1003.1100 — Basis for civil money penalties
• § 1003.1110 — Amount of penalties
• § 1003.1120 — Determinations regarding the amount of penalties
• § 1003.1200 — Basis for civil money penalties
• § 1003.1210 — Amount of penalties
• § 1003.1220 — Determinations regarding the amount of penalties
• § 1003.1300 — Basis for civil money penalties
• § 1003.1310 — Amount of penalties
• § 1003.1320 — Determinations regarding the amount of penalties
• § 1003.1400 — Basis for civil money penalties
• § 1003.1410 — Amount of penalties
• § 1003.1420 — Determinations regarding the amount of penalties
• § 1003.1500 — Notice of proposed determination
• § 1003.1510 — Failure to request a hearing
• § 1003.1520 — Collateral estoppel
• § 1003.1530 — Settlement
• § 1003.1540 — Judicial review
• § 1003.1550 — Collection of penalties and assessments
• § 1003.1560 — Notice to other agencies
• § 1003.1570 — Limitations
• § 1003.1580 — Statistical sampling
• § 1003.1590 — Effect of exclusion
• § 1003.1600 — Reinstatement

PART 1004

• § 1004.1 — Scope and definitions
• § 1004.10 — Statutory obligations of practitioners and other persons
• § 1004.20 — Sanctions
• § 1004.30 — Basic responsibilities
• § 1004.40 — Action on identification of a violation
• § 1004.50 — Meeting with a practitioner or other person
• § 1004.60 — QIO finding of a violation
• § 1004.70 — QIO action on final finding of a violation
• § 1004.80 — QIO report to the OIG
• § 1004.90 — Basis for recommended sanction
• § 1004.100 — Acknowledgement and review of report
• § 1004.110 — Notice of sanction
• § 1004.120 — Effect of an exclusion on program payments and services
• § 1004.130 — Reinstatement after exclusion
• § 1004.140 — Appeal rights

PART 1005

• § 1005.1 — Definitions
• § 1005.2 — Hearing before an administrative law judge
• § 1005.3 — Rights of parties
• § 1005.4 — Authority of the ALJ
• § 1005.5 — Ex parte contacts
• § 1005.6 — Prehearing conferences
• § 1005.7 — Discovery
• § 1005.8 — Exchange of witness lists, witness statements and exhibits
• § 1005.9 — Subpoenas for attendance at hearing
• § 1005.10 — Fees
• § 1005.11 — Form, filing and service of papers
• § 1005.12 — Computation of time
• § 1005.13 — Motions
• § 1005.14 — Sanctions
• § 1005.15 — The hearing and burden of proof
• § 1005.16 — Witnesses
• § 1005.17 — Evidence
• § 1005.18 — The record
• § 1005.19 — Post-hearing briefs
• § 1005.20 — Initial decision
• § 1005.21 — Appeal to DAB
• § 1005.22 — Stay of initial decision
• § 1005.23 — Harmless error

PART 1006

• § 1006.1 — Scope
• § 1006.2 — Contents of subpoena
• § 1006.3 — Service and fees
• § 1006.4 — Procedures for investigational inquiries
• § 1006.5 — Enforcement of a subpoena

PART 1007

• § 1007.1 — Definitions
• § 1007.3 — Statutory basis and organization of rule
• § 1007.5 — Single, identifiable entity requirements of Unit
• § 1007.7 — Prosecutorial authority requirements of Unit
• § 1007.9 — Relationship and agreement between Unit and Medicaid agency
• § 1007.11 — Duties and responsibilities of Unit
• § 1007.13 — Staffing requirements of Unit
• § 1007.15 — Establishment and certification of Unit
• § 1007.17 — Annual recertification of Unit
• § 1007.19 — FFP rate and eligible FFP costs
• § 1007.20 — Circumstances of permissible data mining
• § 1007.21 — Disallowance of claims for FFP
• § 1007.23 — Other applicable HHS regulations

PART 1008

• § 1008.1 — Basis and purpose
• § 1008.3 — Effective period
• § 1008.5 — Matters subject to advisory opinions
• § 1008.11 — Who may submit a request
• § 1008.15 — Facts subject to advisory opinions
• § 1008.18 — Preliminary questions suggested for the requesting party
• § 1008.31 — OIG fees for the cost of advisory opinions
• § 1008.33 — Expert opinions from outside sources
• § 1008.36 — Submission of a request
• § 1008.37 — Disclosure of ownership and related information
• § 1008.38 — Signed certifications by the requestor
• § 1008.39 — Additional information
• § 1008.40 — Withdrawal
• § 1008.41 — OIG acceptance of the request
• § 1008.43 — Issuance of a formal advisory opinion
• § 1008.45 — Rescission, termination or modification
• § 1008.47 — Disclosure
• § 1008.51 — Exclusivity of OIG advisory opinions
• § 1008.53 — Affected parties
• § 1008.55 — Admissibility of evidence
• § 1008.59 — Range of the advisory opinion