42 C.F.R. PART 403--SPECIAL PROGRAMS AND PROJECTS
TITLE 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER A--GENERAL PROVISIONS
PART 403--SPECIAL PROGRAMS AND PROJECTS
Subpart A--[RESERVED]
Subpart B--MEDICARE SUPPLEMENTAL POLICIES
|
|
| State regulation of insurance policies.
|
|
|
|
| Medicare supplemental policy.
|
|
|
|
| General standards for Medicare supplemental policies.
|
|
|
|
| Supplemental Health Insurance Panel.
|
|
|
|
| State with an approved regulatory program.
|
|
|
|
| Requirements and procedures for obtaining certification.
|
|
|
|
| Review and certification of policies.
|
|
|
|
| Submittal of material to retain certification.
|
|
|
|
| Administrative review of CMS determinations.
|
|
|
|
| Loss ratio calculations: General provisions.
|
|
|
|
| Loss ratio date and time frame provisions.
|
|
|
|
| Loss ratio supporting data.
|
|
|
|
| Statement of actuarial opinion.
|
|
Subpart C--RECOGNITION OF STATE REIMBURSEMENT CONTROL SYSTEMS
|
|
| Minimum requirements for State systems--discretionary approval.
|
|
|
|
| Additional requirements for State systems--mandatory approval.
|
|
|
|
| State systems under demonstration projects--mandatory approval.
|
|
|
|
| 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.
|
|
Subpart D--[RESERVED]
Subpart E--BENEFICIARY COUNSELING AND ASSISTANCE GRANTS
|
|
| Basis, scope, and definition.
|
|
|
|
| Number and size of grants.
|
|
Subpart F--[RESERVED]
Subpart G--RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS--BENEFITS, CONDITIONS OF PARTICIPATION, AND PAYMENT
|
|
| 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: Utilization review.
|
|
|
|
| Estimate of expenditures and adjustments.
|
|
|
|
| Monitoring expenditure level.
|
|
|
|
| Basis and purpose of religious nonmedical health care institutions providing home service.
|
|
|
|
| Requirements for coverage and payment of RNHCI home services.
|
|
|
|
| Payments for home services.
|
|
Subpart H--MEDICARE PRESCRIPTION DRUG DISCOUNT CARD AND TRANSITIONAL ASSISTANCE PROGRAM
|
|
| 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.
|
|
