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Code of Federal Regulations Title 42. Public Health § 42.431.630 Coordination of Medicaid with QIOs

Current as of January 02, 2025 | Updated by Findlaw Staff

(a) The State plan may provide for the review of Medicaid services through a contract with a QIO designated under part 462   1 of this chapter. Medicaid requirements for medical and utilization review are deemed to be met for those services or providers subject to review under the contract.

 1

 So in original;  redesignated as Part 475 by 64 FR 66234.

(b) The State plan must provide that the contract with the QIO—

(1) Meets the requirements of § 434.6(a) of this part;

(2) Includes a monitoring and evaluation plan by which the State ensures satisfactory performance by the QIO;

(3) Identifies the services and providers subject to QIO review;

(4) Ensures that the review activities performed by the QIO are not inconsistent with QIO review activities of Medicare services and includes a description of whether and to what extent QIO determinations will be considered conclusive for Medicaid payment purposes.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.431.630 Coordination of Medicaid with QIOs - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-431-630/

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