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8/13/2019 StatePlan Table of Contents

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Revls i cn H2FA-PH-87-4 BERC)YXtCH 1987S E T I O N

.;ECTION ELIGIBILITY2.1 Application Determination of Eligibilityand Furnishing Medicaid 12.2 overage and Conditions of Eligibility 122.3 Residence . . 13

2.6 Financial Eligibility 162.7 Kedicaid Furnished Out o f S ta t e 18

l ryj---+3 OCT 887Supersedes Approval Date Effective Gate UL 0 1987TIi No.

HCFA ID: 1032P/0010P


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Ilevision: HCFA-PM-87-4 BERC)March 1987 OMB N0.:0938-0193

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SECTION PAGE NlJMBERSECTION 3 SERVICES: GENERAL PROVISlONS.. 19

.1 Amount Duration and Scope of Services. .193.2 Coordination of Medicaid with Medicare Part B. 293.3 Medicaid for lndividuals Agc 65 or Overin institutions for Mental Diseases.. .303.4 Special Requirements applicable toSterilization Procedures.. ..313.5 Medicaid for Medicare Cost Sharing forQualified Medicare Beneficiaries.. ..3 1a3.6 Ambulatory Prenatal Care for Pregnant Womenduring Presumptive Eligibility Period.. .31b3.7 Mandatory Managed Care Enrollment.. 31e

TN No. 03-009 J NSupersedes Approval Date Effective DateTN No. 87 08 HCFA ID: 1002P/0010P


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F . e v i 5 i c n hJFh PH 87 4 BERCuARCH 1987

SECTiON PACE lW ERsEC ;:C t: G E l I i F J L PROGRXH ADKINISTRATION . . . . . . . . . . . . . 2

4 1 5thods of Administration . . . . . . . . . . . . . . . . . . 24 . 2 Hearings for Applicants and Recipients . . . . . . . . . . . 34 3 Safeguarding Infornation on Applicants

and Recipients . . . . . . . . . . . . . . . . . . . . . . . 34. . . . . . . . . . . . . . . . . .t ~edicaid uality Control 35

4.5 Eedicaid hgency Fraud Detection andInvestigation Program . . . . . . . . . . . . . . . . . . . . 64 6 Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . 374.7 Xaintenance cf Records . . . . . . . . . . : . . . . . . . . 8. . . . . . . . . . .8 Avziiability of Agency Progrzq Kanuals 394 9 Reporting Provider Payments to theInternal Revenue Service

4.10 Free Choice of Providers4.11 Relations with Standard Setting. . . . . . . . . . . . . . . . . . . . . .nd Survey Agencies 4 2

. . . . . . . . . . . . .12 Consultation to Medical Facilities 4 4. . . . . . . . . . . . . . . . ..13 Required Provider Agreement 454;14 Utilization Control . . . . . . . . . . . . . . . . . . . . . 64.15 Inspections of Care in Skilled Nursin6

m d Intermediate Care Facilities andInstitutions for Mental Diseases . . . . . . . . . . . . . . 14.16 Relations with State Health and VocationalRehabilitation Agencies and Title V Grantees . . . . . . . . 52

. . . . . . . . . . . . . . . . . . . ..17 Liens and Recoveries 534.18 Cost Sharing and Similar Charges . . . . . . . . . . . . . . 54

. . . . . . . . . . . . . . . . . ..19 P a r . e n t for Services . .. 57

O 87 8 tS is; 35 ~ ; e r ; e d e s Approval Date Effective Date

TI: 1 HCFA ID: 1032P/001OP


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Revis ion : HCIA-PM-90- BPDJANUARY 1990

PACE MRQ m4 2 0 Dire c t Payments to C er ta in Rec ip ien t s fo rP hys r c ia ns o r D e n t i s t s S e r v i c e s . . . . . 6 74 2 1 Prohibit ion Against Reassignment ofProvider Claims . . . . . . . . . . . . . 84 2 2 T hird P a r t y L i a b i l i t y . . . . . . . . . . . 6 9

4 2 4 Standards for Payments for Ski l led Nurs ingand In te rmedia te Care Fac i l i ty Serv ices . . . . . . 7 24 2 5 Prostam fo r Licens ing Adm inis t ra to rsof b lurr ing Homes . . . . . . . . 7 3

4 2 7 Di sel os ute of Survey Infor mationand Prov ide r o r Cont rac tor Eva lua tion . . . . . . . 75

4 2 8 Appeals Proces8 fo r Sk i l l ed Nurs ingand I n t o r m e d ia t e Ca r s P a c i l i t i a s . . . . . . . . 74 2 9 Con f l i c t of I n t e r e s t P rov i s ions . . . . . . . 7 74 3 0 Ex clus ion of P rov ide rs and Suspe nsion of

Prac t i t ioners Convic ted and Other Ind iv idua l s . . . . 784 3 1 Disc lomrm of In fom at i on by Provide rsa n d F i s c a l A g a n t s . . . . . . . . . . . 794 3 2 I nc ow and E l i g i b i l i t y V e r i f i c a t i on System . . . . . 794 3 3 Medicaid E l i g i b i l i ty CardsforHoaulmss Zndividuals . . . . . . . 7984 .34 S y s t c ~ t i c lien V e r if i ca t io n f o r E nt it le ma nt s . . . 79b4 3 5 P.rwdies fo r Sk il le d Nursing and Intmmmdiata

am P a c i l i t i m s t h a t Do l o t MeatR e q u i r e m e n t s o f ~ a r t i c i p a t i o n . . . . . . . . 7 9 ~

Tl l o . 9 0 4 5Supotrades .qpproval at ,,/--/:,/ Kffoc t iva Data :mu 1T Ilo.

HC A ID: 100m wl


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LE


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Revision: HCFA PM 91 (BPDAugust 1991 OM No. 0938

SECTIOIJ PAGE NUMBERSSECTION 7 GENER L P R O V I S I O N S . . . . . . . . . . 86

7 1 Plan Amendment8 . . . . . . . . . 867 2 Nondiscrimination 877 3 M a i n t e n a n c e o f A F D C E f f o r t . . 887 4 StateGovernor1a Review. . . . . . . 89

S u p e r s e d e s Approval Datea. ... . HCFA ID: 7982E

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