Title 42, Part 403 — Special Programs and Projects

Basis and scope.

State regulation of insurance policies.

Medicare supplemental policy.

General standards for Medicare supplemental policies.

NAIC model standards.

Loss ratio standards.

Supplemental Health Insurance Panel.

State with an approved regulatory program.

Emblem.

Requirements and procedures for obtaining certification.

Review and certification of policies.

Submittal of material to retain certification.

Loss of certification.

Administrative review of CMS determinations.

Loss ratio calculations: General provisions.

Loss ratio date and time frame provisions.

Calculation of benefits.

Calculation of premiums.

Loss ratio supporting data.

Statement of actuarial opinion.

Basis and purpose.

Definitions.

Minimum requirements for State systems—discretionary approval.

Additional requirements for State systems—mandatory approval.

State systems under demonstration projects—mandatory approval.

Reduction in payments.

Submittal of application.

Evaluation of State systems.

Reconsideration of certain denied applications.

Approval of State systems.

CMS review and monitoring of State systems.

State systems for hospital outpatient services.

Termination of agreements for Medicare recognition of State systems.

Basis and purpose.

Definitions and terms.

Conditions for coverage.

Valid election requirements.

Condition of participation: Patient rights.

Condition of participation: Quality assessment and performance improvement.

Condition of participation: Food services.

Condition of participation: Discharge planning.

Condition of participation: Administration.

Condition of participation: Staffing.

Condition of participation: Physical environment.

Condition of participation: Life safety from fire.

Condition of participation: Building safety.

Condition of participation: Utilization review.

Condition of participation: Emergency preparedness.

Estimate of expenditures and adjustments.

Payment provisions.

Monitoring expenditure level.

Sunset provision.

Basis and purpose of religious nonmedical health care institutions providing home service.

Requirements for coverage and payment of RNHCI home services.

Excluded services.

Payments for home services.

Basis and scope.

Definitions.

General rules for solicitation, application and Medicare endorsement period.

Sponsor requirements for eligibility for endorsement.

Use of transitional assistance funds.

Eligibility and reconsiderations.

Enrollment and disenrollment and associated endorsed sponsor requirements.

HIPAA privacy, security, administrative data standards, and national identifiers.

Marketing limitations and record retention requirements.

Special rules concerning Part C organizations and Medicare cost plans and their enrollees.

Special rules concerning States.

Special rules concerning long-term care and I/T/U pharmacies.

Special rules concerning the territories.

Sanctions, penalties, and termination.

Reimbursement of transitional assistance and associated sponsor requirements.

Purpose and scope.

Definitions.

Reports of payments or other transfers of value to covered recipients.

Reports of physician ownership and investment interests.

Procedures for electronic submission of reports.

Delayed publication for payments made under product research or development agreements and clinical investigations.

Penalties for failure to report.

Preemption of State laws.

Purpose and scope.

Definitions.

Evaluation of models.

Scope.

Definitions.

Pricing information.

Specific presentation requirements.

Compliance.