42 CFR 440.230 - Sufficiency of amount, duration, and scope

Cite as42 CFR 440.230
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229 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
    ...or services for groups of [[Page 5735]] beneficiaries and sufficiency of amount, duration, and scope of Medicaid services, found at 42 CFR 440.230-440.250. The Medicaid balanced billing regulation at 42 CFR Regulations that shape children's access to care in a wide range of areas, including......
  • Cruz v. Zucker, 14-cv-4456 (JSR)
    • United States
    • United States District Courts. 2nd Circuit. United States District Courts. 2nd Circuit. Southern District of New York
    • July 5, 2016
    ...More broadly, "[e]ach service must be sufficient in amount, duration, and scope to reasonably achieve its purpose." 42 C.F.R. § 440.230(b). Although "[t]he [Medicaid] agency may place appropriate limits on a service based on criteria such as medical necessity or on utilizatio......
  • Cruz v. Zucker, No. 14–cv–4456 (JSR).
    • United States
    • United States District Courts. 2nd Circuit. United States District Courts. 2nd Circuit. Southern District of New York
    • July 29, 2015
    ...of the Medicaid Act); (III) violation of 42 U.S.C. §§ 1396a(a)(17), 1396a(a)(10)(B)(i) and their implementing regulation, 42 C.F.R. § 440.230(c) (the "Reasonable Standards Requirement" of the Medicaid Act); (IV) violation of Article I, Section 11 of the New York State Constitution......
  • Roe v. Casey, Nos. 79-1108
    • United States
    • United States Courts of Appeals. United States Court of Appeals (3rd Circuit)
    • May 21, 1980
    ...of a required service . . . to an otherwise eligible recipient solely because of the diagnosis, type of illness, or condition." 42 C.F.R. § 440.230 (1979). In White v. Beal, supra, this court construed a predecessor version of the regulation containing the identical operative language ......
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221 cases
  • Premiertox, Inc. v. Kentucky Spirit Health Plan, Inc., 053012 KYWDC, 1:12CV-00010-JHM
    • United States
    • Federal Cases United States District Courts 6th Circuit United States District Court of Western District of Kentucky
    • May 30, 2012
    ...to the motion to remand, Defendants contend that the services in question were not "medically necessary" as defined in 42 C.F.R. § 440.230 and 42 U.S.C. § 1396d. According to Defendants, the Notice of Amendment defines "medically necessary" or "medical necessity&quo......
  • 661 F.Supp.2d 871 (M.D.Tenn. 2009), 3:98-0168, John B. v. Goetz
    • United States
    • United States District Court of Middle District of Tennessee
    • September 18, 2009
    ...of medically needy" and " [e]ach service must be sufficient in amount, duration and scope to achieve its purpose." 42 C.F.R. § 440.230(a) and Plaintiffs assert the following statutes under the Medicaid Act, 42 U.S.C. § 1396a(a)(43), 42 U.S.C. § 1396d(a), 42 U.S.C. § 1396(r)(1......
  • 177 F.Supp.2d 78 (D.N.H. 2001), Civ. 99-558, Bryson v. Shumway
    • United States
    • United States District Courts. 1st Circuit. District of New Hampshire
    • October 23, 2001
    ...judgment on Counts II, VI, and VII. The court considers each count in turn. I. Count I: 42 U.S.C. §§ 1396a(a) (17) and (19) & 42 C.F.R. §§ 440.230(b) and (d)--Right to Effective Service In Count I, plaintiffs claim that they have been denied effective services to which they are entitled......
  • 410 F.Supp.2d 18 (D.Mass. 2006), Civ. A. 01-30199, Rosie D. v. Romney
    • United States
    • United States District Courts. 1st Circuit. District of Massachusetts
    • January 26, 2006
    ...303, 105 S.Ct. 712, 83 L.Ed.2d 661 (1985), Page 25 quoted in Pharm. Research & Mfrs., 538 U.S. at 665, 123 S.Ct. 1855; see also 42 C.F.R. § 440.230(d) (2005) (allowing states to "place appropriate limits on service based on such criteria as medical necessity or on utilization contr......
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1 books & journal articles
9 provisions

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