42 CFR 456.2 : 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) — General Provisions (§ 456.1 To § 456.6) — State plan requirements.

4 Aug 2016

(a) A State plan must provide that the requirements of this part are met.

(b) These requirements may be met by the agency by:

(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.

(c) In accordance with § 431.15 of this subchapter, FFP will be available for expenses incurred in meeting the requirements of this part.

42 CFR 456.2
[46 FR 48566, Oct. 1, 1981, as amended at 50 FR 15327, Apr. 17, 1985; 51 FR 43198, Dec. 1, 1986]