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us/regulation/42/457/subpart-L — Subpart L - Managed Care · Axiom

Axiom
US Federal
Regulations
Title 42
Part 457

Subpart L - Managed Care

25 sections

Basis, scope, and applicability
Standard contract requirements
Rate development standards and medical loss ratio
Non-emergency medical transportation PAHPs
Information requirements
Provider discrimination prohibited
Requirements that apply to MCO, PIHP, PAHP, PCCM, and PCCM entity contracts involving Indians, Indian health care provider (IHCP), and Indian managed care entities (IMCE)
Enrollment process
Disenrollment
Conflict of interest safeguards
Continued services to enrollees
Network adequacy standards
Enrollee rights
Provider-enrollee communication
Marketing activities
Liability for payment
Emergency and poststabilization services
Access standards
Structure and operation standards
Quality measurement and improvement
External quality review
Grievance system
Sanctions
Conditions necessary to contract as an MCO, PAHP, or PIHP
Program integrity safeguards