State Plan Under Title XIX Of The Social Security Act Medical Assistance Program

Title Page

Table of Contents page

List of attachments

SECTION 1 .Single State Agency Organization

1.1 Designation and Authority

1.2 Organization for Administration

1.3 Statewide Operation

1.4 State Medical Care Advisory Committee

1.5 Pediatric Immunization Program

SECTION 2 Coverage And Eligibility

2.1 Application, Determination of Eligibility and Furnishing Medicaid

2.2 Coverage and Conditions of Eligibility

2.3 Residence

2.4 Blindness

2.5 Disability

2.6 Financial Eligibility

2.7 Medicaid Furnished Out of State


3.1 Amount, Duration, and Scope of Services

3.2 Coordination of Medicaid with Medicare Part B

3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases

3.4 Special Requirements Applicable to Sterilization Procedures

3.5 Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries

3.6 Ambulatory Prenatal Care for Pregnant Women during Presumptive Eligibility Period



4.1 Methods of Administration

4.2 Hearings for Applicants and Recipients

4.3 Safeguarding Information on Applicants and Recipients

4.4 Medicaid Quality Control

4.5 Medicaid Agency Fraud Detection and Investigation Program

4.6 Reports

4.7 Maintenance of Records

4.8 Availability of Agency Program Manuals

4.9 Reporting Provider Payments to the Internal Revenue Service

4.10 Free Choice of Providers

4.11 Relations with Standard-Setting and Survey Agencies

4.12 Consultation to Medical Facilities

4.13 Required Provider Agreement

4.14 Utilization Control

4.15 Inspection of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases

4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees

4.17 Liens and Recoveries

4.18 Cost Sharing and Similar Charges

4.19 Payment for Services

4.20 Direct Payments to Certain Recipients for Physicians' or Dentists' Services

4.21 Prohibition Against Reassignment of Provider Claims

4.22 Third Party Liability

4.23 Use of Contracts

4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services

4.25 Program for Licensing Administrators of Nursing Homes

4.26 Drug Utilization Review Program

4.27 Disclosure of Survey Information and Provider or Contractor Evaluation

4.28 Appeals Process for Skilled Nursing and Intermediate Care Facilities

4.29 Conflict of Interest Provisions

4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals

4.31 Disclosure of Information by Providers and Fiscal Agents

4.32 Income and Eligibility Verification System

4.33 Medicaid Eligibility Cards for Homeless Individuals

4.34 Systematic Alien Verification for Entitlement

4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do No Meet Requirements of Participation

4.36 Required Coordination Between the Medicaid and WIC Programs

4.37 [Reserved]

4.38 Nurse Aide Training and Competency Evaluation For Nursing Facilities

4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities

4.40 Survey & Certification Process

4.41 Resident Assessment for Nursing Facilities

4.42 Employee Education About False Claims Recoveries .


5.1 Standards of Personnel Administration

5.2 [Reserved]

5.3 Training Program: Sub professional and Volunteer Programs


6.1 Fiscal Policies and Accountability

6.2 Cost Allocation

6.3 State Financial Participation


7.1 Plan Amendments

7.2 Nondiscrimination

7.3 State Governor's Review

7.4 State Governor's Review


State Plan Amendment (SPA) Approvals

Report Fraud