Code of Federal Regulations Title 42. Public Health § 42.456.2 State plan requirements

(1) Assuming direct responsibility for assuring that the requirements of this part are met;  or

(2) Deeming of medical and utilization review requirements if the agency contracts with a QIO to perform that review, which in the case of inpatient acute care review will also serve as the initial determination for QIO medical necessity and appropriateness review for patients who are dually entitled to benefits under Medicare and Medicaid.