Section 4 - General Program Administration

     

    Section            Attachments
    4.1   Methods of Administration  
    4.2   Hearings for Applicants and Recipients   
    4.3   Safeguarding Information on Applicants and Recipients      
    4.4   Medicaid Quality Control   
    4.5   Medicaid Agency Fraud Detection and Investigation Program    
    4.6  Reports   
    4.7  Maintenance of Records  
    4.8  Availability of Agency Program Manuals        
    4.9  Reporting Provider Payments to the Internal Revenue Service (IRS)  
    4.10   Free Choice of Providers                     Attachment 4.10-A   None
    4.11   Relations with Standard-Setting and Survey Agencies    Attachment 4.11-A Standards for Institutions
    4.12   Consultation to Medical Facilities   
    4.13  Required Provider Agreement   
    4.14  Utilization and Quality Control  Attachment 4.14-A   None 

    Attachment 4.14-B  Utilization Review Plans 
    4.15  Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases   
    4.16  Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees       Attachment 4.16-A Interagency Agreements
    4.17   Liens and Recoveries       Attachment 4.17-A   Liens and Adjustment or Recoveries 
    4.18  Cost Sharing and Similar Charges       Attachment 4.18-A  Charges Imposed on the Categorically Needy for Services Other than Those Provided Under Section 1905(a)(1) through (5) and (7) of the Act

    Attachment 4.18-B   None 

    Attachment 4.18-C   Charges Imposed on the Medically Needy 
    4.19   Payment for Services       Attachment 4.19  Assurances - Rates Link
    Attachment 4.19-A  Assurances

    Attachment 4.19-A  Payment for Inpatient Hospital Services Assurances and Related Information 

    Attachment 4.19-B   Payment for Medical Care and Services

    Supplement 1 to Attachment 4.19-B   Methods and Standards for Establishing Payment Rates - Other Types of Care
        
    Supplement 2 to Attachment 4.19-B   Standards for Establishing payment for Organ Transplant Services and Out-Of-State Emergency Services

    Supplement 3 to Attachment 4.19-B Payments for Selected Critical Access Hospitals for Providing Telehealth Services

    Attachment 4.19-B    Assurances

    Attachment 4.19-C   Payment for Reserved Beds for Therapeutic Leave of Absence 

    Attachment 4.19-D   Payment for Nursing Facilities Assurances and Related Information  

    Attachment 4.19-D   Payment for Long-Term Nursing Facility Services Methods and Standards

    Attachment 4.19-E   Definition of a Claim
    4.20  Direct Payments to Certain Recipients for Physicians' or Dentists' Services  
    4.21  Prohibition Against Reassignment of Provider Claims  Attachment 4.21-AProvider Payments 
    4.22   Third Party Liability Attachment 4.22-A  Expansion of Descriptions of Procedures and Methodologies List in 4.22(b) of the State Plan

    Attachment 4.22-B   Post-Payment Recovery

    Attachment 4.22-C
      State Method on Cost Effectiveness of Employer-Based Group Health Plans

    Attachment 4.22   Supplement to Attachment 4.22
    4.23   Use of Contracts        
    4.24   Standards for Payments for Skilled Nursing and Intermediate Care Facility Services   
    4.25   Program for Licensing Administrators of Nursing Homes  
    4.26   Drug Utilization Review Program   
    4.27   Disclosure of Information and Provider or Contractor Evaluation   
    4.28  Appeals Process   
    4.29  Conflict of Interest Provisions  
    4.30   Exclusion of Providers and Suspension of Practitioners and Other Individuals Attachment 4.30  Sanctions for Psychiatric Hospitals
    4.31  Disclosure of Information by Provides and Fiscal Agents   
    4.32  Income and Eligibility Verification System  Attachment 4.32-A  Income and Eligibility Verification System Procedures Requests to Other State Agencies
    4.33   Medicaid Eligibility Cards for Homeless Individuals  Attachment 4.33-A  Methods for Issuance of Medicaid Eligibility Cards to Homeless Individuals 
    4.34  Systematic Alien Verification for Entitlements  Attachment 4.34-A  Requirements for Advance Directives Under State Plans for Medical Assistance
    4.35  Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements for Participation      Attachment 4.35-A   Enforcement of Compliance for Nursing Facilities

    Attachment 4.35-B   Enforcement of Compliance for Nursing Facilities - Termination of Provider Agreement

    Attachment 4.35-C  Enforcement of Compliance for Nursing Facilities - Temporary Management

    Attachment 4.35-D   Enforcement of Compliance for Nursing Facilities - Denial of Payment for New Admissions 

    Attachment 4.35-E   Enforcement of Compliance for Nursing Facilities - Civil Money Penalty

    Attachment 4.35-F Enforcement of Compliance for Nursing Facilities - State Monitoring

    Attachment 4.35-G Enforcement of Compliance for Nursing Facilities - Transfer of Residents; Transfer of Residents with Closure of Facility

    Attachment 4.35-H Enforcement of Compliance for Nursing Facilities - Additional Remedies
    4.36  Required Coordination Between the     Medicaid and WIC programs  
    4.38  Nurse Aid Training and Competency Evaluation for Nursing Facilities  Attachment 4.38-A  Disclosure of Additional Registry Information 
    4.39   Preadmission Screening and Annual Resident Review in Nursing Facilities  Attachment 4.39-A  Definition of Specialized Services 
    4.40   Survey and Certification Process       Attachment 4.40-A   Survey and Certification Education Program 

    Attachment 4.40-B   Process for the Investigation of Allegations of Resident Neglect and Abuse and Misappropriation of Resident Property

    Attachment 4.40-C   Procedures for Scheduling and Conduct of Standard Surveys

    Attachment 4.40-D  Programs to Measure and Reduce Inconsistency 

    Attachment 4.40-E   Process for Investigations of Complaints and Monitoring 
    4.41   RESERVED  
    4.42   Employee Education About False Claims Recoveries  Attachment 4.42-A   Methodologies for Compliance Oversight
    4.43   Medicaid Integrity Program   
    4.44   Payments to Institutions or Entities Located Outside of the United States        
    4.46   Provider Screening and Enrollment  

      Last Edited: 5/9/2017