Section 4 – General Program Administration
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Sections and Attachments
| Section Pages | Attachment Pages |
|---|---|
| 4.1 Methods of Administration | |
| 4.2 Hearings of Applicants and Recipients | |
| 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 | |
| 4.7 Maintenance of Records | |
| 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 |
| 4.19 Payment for Services | 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 | Attachment 4.42-A Methodologies for Compliance Oversight |
| 4.43 Employee Education About False Claims Recoveries | |
| 4.44 Medicaid Prohibition on Payments to Institutions Located Outside of the United States | |
| 4.46 Provider Screening and Enrollment |