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Code of Federal Regulations Title 42. Public Health § 42.456.650 Basis, purpose and scope

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

(a) Basis. Section 1903(g) of the Act requires that FFP for long-stay inpatient services at a level of care be reduced, by a specified formula, for any quarter in which a State fails to make a satisfactory showing that it has an effective program of utilization control for that level of care.

(b) Purpose. This subpart specifies—

(1) What States must do to make a satisfactory showing;

(2) How the Administrator will determine whether reductions will be imposed;  and

(3) How the required reductions will be implemented.

(c) Scope. The reductions required by this subpart do not apply to—

(1) Services provided under a contract with a health maintenance organization;  or

(2) Facilities in which a QIO is performing medical and utilization reviews under contract with the Medicaid agency in accordance with § 431.630 of this chapter.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.456.650 Basis, purpose and scope - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-456-650/

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