Section 4 - General Program Administration
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SECTIONS AND ATTACHMENTS
4.1 Methods of Administration PDF
4.2 Hearings of Applicants and Recipients PDF
4.3 Safeguarding Information on Applicants and Recipients PDF
4.4 Medicaid Quality Control PDF
Attachment 4.4-A MMIS Alternative Claims Processing Assessment System PDF
4.5 Medicaid Recovery Audit Contractor Program PDF
4.6 Reports PDF
4.7 Maintenance of Records PDF
4.8 Availability of Agency Program Manuals PDF
4.9 Reporting Provider Payments to Internal Revenue Service PDF
4.10 Free Choice of Providers PDF
4.11 Relations with Standard-Setting and Survey Agencies PDF
Attachment 4.11-A Standard Setting Authority for Institutions PDF
4.12 Consultation to Medical Facilities PDF
4.13 Required Provider Agreemen PDF
4.14 Utilization/Quality Control PDF
4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases PDF
4.16 Relations with State Health and Vocation Rehabilitation Agencies and Title V Grantees PDF
Attachment 4.16-A Interagency Agreements of the Department of Health Services Regarding Medi-Cal Services PDF
4.17 Liens and Adjustments or Recoveries PDF
Attachment 4.17-A IHSS Services from Estate Recovery & Clarify Estate Recovery Process PDF
4.18 Recipient Cost Sharing and Similar Charges PDF
Attachment 4.18-A through E PDF
4.19 Payment for Services PDF
Attachments 4.19-A through F
4.20A Direct Payments to Certain Recipients for Physicians' or Dentists' Services PDF
Attachment 4.20-A Conditions for Direct Payment for Physician's & Dentists' Services PDF
Attachment 4.20-B Conditions for Direct Beneficiary Reimbursement PDF
4.21 Prohibition Against Reassignment of Provider Claims PDF
4.22 Third Party Liability PDF
Attachment 4.22-A
Attachment 4.22-B PDF
Attachment 4.22-C PDF
Attachment 4.22-D PDF
4.23 Use of Contracts PDF
4.24 Standards for Payments for Nursing Facility and Intermediate Care Facility for the Mentally Retarded Services PDF
4.25 Program for Licensing Administrators for Nursing Homes PDF
4.26 Drug Utilization Review Program PDF
4.27 Disclosure of Survey Information and Provider or Contractor Evaluation PDF
4.28 Appeals Process PDF
4.29 Conflict of Interest Provisions PDF
4.30 Exclusion of Providers and Suspension of Practitioners and Other Individuals PDF
Attachment 4.30 Sanctions of Pyschiatric Hospitals/ MCOs and PCCMs PDF
4.31 Disclosure of Information by Providers and Fiscal Agents PDF
4.32 Attachment 4.32-A: Income and Eligibility Verification System Procedures Requests to Other State Agencies PDF
4.33 Medicaid Eligibility Cards for Homeless Individuals PDF
Attachment 4.33 Method of Issuance of Medicaid Eligibility Claims to Homeless Individuals PDF
4.34 Systematic Alien Verification for Entitlements PDF
Attachment 4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance PDF
Supplement 1 to Attachment 4.34-A Implementation of Patient Self-Determination Provision of OBRA 90 PDF
4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation PDF
Attachment 4.35- A through H PDF
4.36 Required Coordination Between the Medicaid and WIC ProgramsPDF
4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities PDF
4.39 Preadmission Screening and Resident Review in Nursing Facilities PDF
Attachment 4.39 Definition of Specialized Services PDF
Attachment 4.39-A Categorical Determinations PDF
4.40 Survey and Certification Process PDF
Attachment 4.40- A through E PDF
4.41 Resident Assessment for Nursing Facilities PDF
4.42 Employee Education About False Claims Recoveries PDF
Attachment 4.42-A Methodologies for Compliance Oversight PDF
4.43 Employee Education About False Claims RecoveriesPDF
4.44 Medicaid Prohibition on Payments to Institutions Located Outside of the United States PDF
4.46 Provider Screening and Enrollment PDF