42 C.F.R. § 438.1 - Basis and scope

Cite as42 C.F.R. § 438.1
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5 practice notes
  • Securing Updated and Necessary Statutory Evaluations Timely
    • United States
    • Centers For Medicare And Medicaid Services,Public Health Service,The Inspector General Office
    • Invalid date
    ...regulation at 42 CFR 447.15. Regulations that shape children's access to care in a wide range of areas, including but not limited to: 42 CFR 438.1-438.930-- Medicaid Managed Care; 42 CFR 447.56--Limitations on premiums and cost sharing; 42 CFR 447.203--Documentation of access to care and se......
  • Pharmacy Buying Assoc., Inc. v. Sebelius, Cases No. A–12–CA–156–SS.
    • United States
    • United States District Courts. 5th Circuit. Western District of Texas
    • October 29, 2012
    ...the managed care organizations (MCOs) enter into comprehensive risk contracts with a state. See42 U.S.C. § 1396b(m) (defining MCOs); 42 C.F.R. § 438.1(a) (rules regarding MCOs and contracts with a state). Under a risk contract, the MCO is paid a “capitation payment,” 4 and in return assumes......
  • United States ex rel. Fisher v. Iasis Healthcare LLC, No. CV-15-00872-PHX-JJT
    • United States
    • United States District Courts. 9th Circuit. United States District Courts. 9th Circuit. District of Arizona
    • November 8, 2016
    ...care organizations ("MCOs") enter into comprehensive risk contracts with the state. See 42 U.S.C. § 1396b(m) (defining MCOs);Page 3 42 C.F.R. § 438.1(a) (rules regarding MCOs and state contracts). Under a risk contract, the MCO is paid a "capitation payment," and in return assumes risk for ......
  • K.C. v. Shipman, No. 12–1575.
    • United States
    • U.S. Court of Appeals — Fourth Circuit
    • May 10, 2013
    ...expressly contemplated, for example in the context of MCOs like PBH that manage the provision of Medicaid on the state's behalf. See42 C.F.R. §§ 438.1(b), 438.6. But the single state agency requirement does mean that a delegation can go only so far: where the agency makes a final decision, ......
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4 cases
  • Pharmacy Buying Assoc., Inc. v. Sebelius, Cases No. A–12–CA–156–SS.
    • United States
    • United States District Courts. 5th Circuit. Western District of Texas
    • October 29, 2012
    ...the managed care organizations (MCOs) enter into comprehensive risk contracts with a state. See42 U.S.C. § 1396b(m) (defining MCOs); 42 C.F.R. § 438.1(a) (rules regarding MCOs and contracts with a state). Under a risk contract, the MCO is paid a “capitation payment,” 4 and in return assumes......
  • United States ex rel. Fisher v. Iasis Healthcare LLC, No. CV-15-00872-PHX-JJT
    • United States
    • United States District Courts. 9th Circuit. United States District Courts. 9th Circuit. District of Arizona
    • November 8, 2016
    ...care organizations ("MCOs") enter into comprehensive risk contracts with the state. See 42 U.S.C. § 1396b(m) (defining MCOs);Page 3 42 C.F.R. § 438.1(a) (rules regarding MCOs and state contracts). Under a risk contract, the MCO is paid a "capitation payment," and in return assumes risk for ......
  • K.C. v. Shipman, No. 12–1575.
    • United States
    • U.S. Court of Appeals — Fourth Circuit
    • May 10, 2013
    ...expressly contemplated, for example in the context of MCOs like PBH that manage the provision of Medicaid on the state's behalf. See42 C.F.R. §§ 438.1(b), 438.6. But the single state agency requirement does mean that a delegation can go only so far: where the agency makes a final decision, ......
  • K.C. v. Shipman, No. 12-1575
    • United States
    • United States Courts of Appeals. United States Court of Appeals (4th Circuit)
    • May 10, 2013
    ...expressly contemplated, for example in the context of MCOs like PBH that manage the provision of Medicaid on the state's behalf. See 42 C.F.R. §§ 438.1(b), 438.6. But the single state agency requirement does mean that a delegation can go only so far: where the agency makes a final decision,......
1 provisions
  • Securing Updated and Necessary Statutory Evaluations Timely
    • United States
    • Centers For Medicare And Medicaid Services,Public Health Service,The Inspector General Office
    • Invalid date
    ...regulation at 42 CFR 447.15. Regulations that shape children's access to care in a wide range of areas, including but not limited to: 42 CFR 438.1-438.930-- Medicaid Managed Care; 42 CFR 447.56--Limitations on premiums and cost sharing; 42 CFR 447.203--Documentation of access to care and se......

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