Title 42, Chapter IV — Chapter IV

Introduction; Definitions

General Administrative Requirements

Civil Money Penalties, Assessments, and Exclusions

Special Programs and Projects

Federal Health Insurance for the Aged and Disabled

Hospital Insurance Eligibility and Entitlement

Supplementary Medical Insurance (Smi) Enrollment and Entitlement

Premiums for Supplementary Medical Insurance

Hospital Insurance Benefits

Supplementary Medical Insurance (Smi) Benefits

Exclusions From Medicare and Limitations on Medicare Payment

Prospective Payment Systems for Inpatient Hospital Services

Principles of Reasonable Cost Reimbursement; Payment for End-stage Renal Disease Services; Prospectively Determined Payment Rates for Skilled Nursing Facilities; Payment for Acute Kidney Injury Dialysis

Payment for Part B Medical and Other Health Services

Services Furnished by Physicians in Providers, Supervising Physicians in Teaching Settings, and Residents in Certain Settings

Ambulatory Surgical Services

Health Maintenance Organizations, Competitive Medical Plans, and Health Care Prepayment Plans

Hospice Care

Prospective Payment Systems for Hospital Outpatient Department Services

Program Integrity: Medicare

Medicare Contracting

Medicare Advantage Program

Voluntary Medicare Prescription Drug Benefit

Conditions for Medicare Payment

Medicare Shared Savings Program

Review of National Coverage Determinations and Local Coverage Determinations

Medicare Part B Drug Inflation Rebate Program

Medicare Part D Drug Inflation Rebate Program

Grants to States for Medical Assistance Programs

State Organization and General Administration

State Personnel Administration

State Fiscal Administration

Contracts

Eligibility in the States, District of Columbia, the Northern Mariana Islands, and American Samoa

Eligibility in Guam, Puerto Rico, and the Virgin Islands

Medicaid Quality

Managed Care

Services: General Provisions

Services: Requirements and Limits Applicable to Specific Services

Standards for Payment to Nursing Facilities and Intermediate Care Facilities for Individuals With Intellectual Disabilities

Payments for Services

Program Integrity: Medicaid

Utilization Control

Allotments and Grants to States

Programs of All-inclusive Care for the Elderly (Pace)

Quality Improvement Organizations

Quality Improvement Organization Review

Reconsiderations and Appeals

Acquisition, Protection, and Disclosure of Quality Improvement Organization Information

Conditions of Participation for Hospitals

Requirements for States and Long Term Care Facilities

Home Health Services

Conditions of Participation: Specialized Providers

Conditions for Coverage of Specialized Services Furnished by Suppliers

Survey, Certification, and Enforcement Procedures

Provider Agreements and Supplier Approval

Certification of Certain Health Facilities

Laboratory Requirements

Conditions for Coverage for End-stage Renal Disease Facilities

Standards for the Electronic Health Record Technology Incentive Program

Appeals Procedures for Determinations That Affect Participation in the Medicare Program and for Determinations That Affect the Participation of Icfs/iid and Certain Nfs in the Medicaid Program

Establishment of the Health Care Infrastructure Improvement Program

Comprehensive Care for Joint Replacement Model

Standard Provisions for Mandatory Innovation Center Models and Specific Provisions for Certain Models

Administration, Eligibility, Essential Health Benefits, Performance Standards, Service Delivery Requirements, Premium and Cost Sharing, Allotments, and Reconcilation