42 CFR 456.650 : Public Health (Part 1 To Parts 1009-1099) — (§ 430.0 To Part 481) — Centers For Medicare & Medicaid Services, Department Of Health And Human Services (Continued) (§ 430.0 To Part 481) — Medical Assistance Programs (§ 430.0 To § 456.725) — Utilization Control (§ 456.1 To § 456.725) — Penalty For Failure To Make A Satisfactory Showing Of An Effective Institutional Utilization Control Program (§ 456.650 To § 456.657) — Basis, purpose and scope.

(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.