4.1 Methods of Administration
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4.2 Hearings of Applicants and Recipients
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4.3 Safeguarding Information on Applicants and Recipients | |
4.4 Medicaid Quality Control |
Attachment 4.4-A MMIS Alternative Claims Processing Assessment System |
4.5 Medicaid Recovery Audit Contractor Program | |
4.6 Reports
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4.7 Maintenance of Records
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4.8 Availability of Agency Program Manuals | |
4.9 Reporting Provider Payments to Internal Revenue Service | |
4.10 Free Choice of Providers | |
4.11 Relations with Standard-Setting and Survey Agencies |
Attachment 4.11-A Standard Setting Authority for Institutions |
4.12 Consultation to Medical Facilities | |
4.13 Required Provider Agreement | |
4.14 Utilization/Quality Control | |
4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases | |
4.16 Relations with State Health and Vocation Rehabilitation Agencies and Title V Grantees |
Attachment 4.16-A Interagency Agreements of the Department of Health Services Regarding Medi-Cal Services |
4.17 Liens and Adjustments or Recoveries |
Attachment 4.17-A IHSS Services from Estate Recovery & Clarify Estate Recovery Process |
4.18 Recipient Cost Sharing and Similar Charges |
Attachment 4.18-A Categorically Needy Services Other than those Provided Under Section 1905(a)(1) through (5) and (8) Attachment 4.18-B No attachment
Attachment 4.18-C Services For Medically Needy
Attachment 4.18-D Premiums Imposed on Low Income Pregnant Women and Infants
Attachment 4.18-E Optional Sliding Scale Premiums Imposed on Qualified Disabled and Working Individuals
Attachment 4.18-F Alternative Premiums and Cost-Sharing Changes
Attachment 4.18 Forms G1-G2c Medicaid Premiums and Cost Sharing
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4.19 Payment for Services
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Attachments 4.19-A through F |
4.20A Direct Payments to Certain Recipients for Physicians' or Dentists' Services |
Attachment 4.20-A Conditions for Direct Payment for Physician's & Dentists' Services
Attachment 4.20-B Conditions for Direct Beneficiary Reimbursement |
4.21 Prohibition Against Reassignment of Provider Claims | |
4.22 Third Party Liability |
Attachment 4.22-A
Attachment 4.22-B
Attachment 4.22-C
Attachment 4.22-D |
4.23 Use of Contracts | |
4.24 Standards for Payments for Nursing Facility and Intermediate Care Facility for the Mentally Retarded Services | |
4.25 Program for Licensing Administrators for Nursing Homes | |
4.26 Drug Utilization Review Program | |
4.27 Disclosure of Survey Information and Provider or Contractor Evaluation | |
4.28 Appeals Process | |
4.29 Conflict of Interest Provisions | |
4.30 Exclusion of Providers and Suspension of Practitioners and Other Individuals |
Attachment 4.30 Sanctions of Psychiatric Hospitals/ MCOs and PCCMs |
4.31 Disclosure of Information by Providers and Fiscal Agents | |
4.32 Attachment 4.32-A: Income and Eligibility Verification System Procedures Requests to Other State Agencies | |
4.33 Medicaid Eligibility Cards for Homeless Individuals |
Attachment 4.33 Method of Issuance of Medicaid Eligibility Claims to Homeless Individuals |
4.34 Systematic Alien Verification for Entitlements |
Attachment 4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance
Supplement 1 to Attachment 4.34-A Implementation of Patient Self-Determination Provision of OBRA 90 |
4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation |
Attachment 4.35- A through H |
4.36 Required Coordination Between the Medicaid and WIC Programs | |
4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities | |
4.39 Preadmission Screening and Resident Review in Nursing Facilities |
Attachment 4.39 Definition of Specialized Services
Attachment 4.39-A Categorical Determinations |
4.40 Survey and Certification Process |
Attachment 4.40- A through E |
4.41 Resident Assessment for Nursing Facilities | |
4.42 Employee Education About False Claims Recoveries
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Attachment 4.42-A Methodologies for Compliance Oversight
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4.43 Employee Education About False Claims Recoveries | |
4.44 Medicaid Prohibition on Payments to Institutions Located Outside of the United States | |
