| 4.1 Methods of Administration |
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| 4.2 Hearings for Applicants and Recipients |
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| 4.3 Safeguarding Information on Applicants and Recipients |
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| 4.4 Medicaid Quality Control |
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| 4.5 Medicaid Agency Fraud Detection and Investigation Program |
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| 4.6 Reports |
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| 4.7 Maintenance of Records |
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| 4.8 Availability of Agency Program Manuals |
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| 4.9 Reporting Provider Payments to the Internal Revenue Service (IRS) |
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| 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 |
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| 4.13 Required Provider Agreement |
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| 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 |
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| 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 Assurances
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 |
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| 4.21 Prohibition Against Reassignment of Provider Claims |
Attachment 4.21-A Provider 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 Third Party Liability - Payment of Claims
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 |
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| 4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services |
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| 4.25 Program for Licensing Administrators of Nursing Homes |
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| 4.26 Drug Utilization Review Program |
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| 4.27 Disclosure of Information and Provider or Contractor Evaluation |
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| 4.28 Appeals Process |
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| 4.29 Conflict of Interest Provisions |
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| 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 |
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| 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 |
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| 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 |
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| 4.42 Employee Education About False Claims Recoveries |
Attachment 4.42-A Methodologies for Compliance Oversight |
| 4.43 Medicaid Integrity Program |
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| 4.44 Payments to Institutions or Entities Located Outside of the United States |
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| 4.46 Provider Screening and Enrollment |
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