Home/CFR/Title 42/Part 431
FEDERAL · 42 CFR

Part 431 — State Organization and General Administration

120 sections · Title 42: Public Health

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