Cover
Table of Contents
List of Attachments
Medicaid Administration
A1 -State Plan Administration Designation and Authority
A2 -State Plan Administration Organization and Administration
A3 -State Plan Administration Assurances
1.4 Tribal Consultation Requirements
1.5 Pediatric Immunization Program
Medicaid Premiums and Cost Sharing
G1 - Cost Sharing Requirements
G2a - Cost Sharing Amounts - Categorically Needy Individuals
G2b - Cost Sharing Amounts - Medically Needy Individuals
G2c - Cost Sharing Amounts - Targeting
G3 - Cost Sharing Limitations
Medicaid Eligibility
Medicaid State Plan Eligibility
S10 - MAGI Based Income Methodologies
S14 - AFDC Income Standards
S16 - Presumptive Eligibility for Children
S21 - Presumptive Eligibility by Hospitals
S25 - Eligibility Groups - Mandatory Coverage Parents and Other Caretaker Relatives
S28 - Eligibility Groups - Mandatory Coverage Pregnant Women
S30 - Eligibility Groups - Mandatory Coverage Infants and Children Under Age 19
S32 - Mandatory Coverage Adult Group
S33 - Eligibility Groups - Mandatory Coverage Former Foster Care Children
S50 - Eligibility Groups - Options for Coverage Individuals Above 133% FPL
S51 - Eligibility Groups - Options for Coverage Optional Coverage of Parents and Other Caretaker Relatives
S52 - Eligibility Groups - Options for Coverage Reasonable Classification of Individuals Under Age 21
S53 - Eligibility Groups - Options for Coverage Children with Non IV-E Adoption Assistance
S54 - Eligibility Groups - Options for Coverage Optional Targeted Low Income Children
S55 - Eligibility Groups - Options for Coverage Individuals with Tuberculosis
S57 - Eligibility Groups - Options for Coverage Independent Foster Care Adolescents
S59 - Eligibility Groups - Options for Coverage Individuals Eligible for Family Planning Services
S88 - Non-Finanical Eligibility State Residency
S89 - Non Financial Eligibility Citizenship and Non Citizen Eligibility
S94 - General Eligibility Requirements Eligibility Process
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3.1 Amount, Duration, and Scope of Services |
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3.2 Coordination of Medicaid with Medicare Part B |
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3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases |
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3.4 Special Requirements Applicable to Sterilization Procedures |
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3.5 Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries |
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3.6 Ambulatory Prenatal Care for Pregnant Women during Presumptive Eligibility Period |
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4.1 Methods of Administration |
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4.2 Hearings for Applicants and Recipients |
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4.3 Safeguarding Information on Applicants and Recipients |
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4.4 Medicaid Quality Control |
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4.5 Medicaid Agency Fraud Detection and Investigation Program |
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4.6 Reports |
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4.7 Maintenance of Records |
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4.8 Availability of Agency Program Manuals |
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4.9 Reporting Provider Payments to the Internal Revenue Service |
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4.10 Free Choice of Providers |
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4.11 Relations with Standard-Setting and Survey Agencies |
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4.12 Consultation to Medical Facilities |
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4.13 Required Provider Agreement |
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4.14 Utilization Control |
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4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases |
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4.17 Liens and Recoveries |
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4.18 Cost Sharing and Similar Charges |
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4.19 Payment for Services |
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4.20 Direct Payments to certain Recipients for Physicians' or Dentists' Services |
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4.21 Prohibition Against Reassignment of Provider Claims |
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4.22 Third Party Liability |
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4.23 Use of Contracts |
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4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services |
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4.25 Program for Licensing Administrators of Nursing Homes |
4.26 Drug Utilization Review Program |
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4.27 Disclosure of Survey information and Provider or Contractor Evaluation |
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4.28 Appeals Process for Skilled Nursing and Intermediate Care Facilities |
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4.29 Conflict of Interest Provisions |
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4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals |
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4.31 Disclosure of Information by Providers and Fiscal Agents |
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4.32 Income and Eligibility Verification System |
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4.33 Medicaid Eligibility Cards for Homeless Individuals |
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4.34 Systematic Alien Verification for Entitlements |
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4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation |
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4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities |
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4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities |
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4.40 Survey and Certification Process |
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4.41 Resident Assessment for Nursing Facilities |
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4.43 Frequency and Description of Method of Compliance Oversight |
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5.1Standards of Personnel Administration |
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5.3Training Programs; Subprofessional and Volunteer Programs |
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6.1 Fiscal Policies and Accountability |
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6.2 Cost Allocation |
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6.3 State Financial Participation |
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7.1Plan Amendments |
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7.2Nondiscrimination |
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7.3Maintenance of AFDS Effort |
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7.4State Governor's Review
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Assurance Pages |
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