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FEDERAL · 42 CFR

Part 457 — Allotments and Grants to States

161 sections · Title 42: Public Health

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