Current through February 29, 2024
Section 456.650 - Basis, purpose and scope(a)Basis. Section 1903(g) of the Act requires that FFP for long-stay inpatient services at a level of care be reduced, by a specified formula, for any quarter in which a State fails to make a satisfactory showing that it has an effective program of utilization control for that level of care.(b)Purpose. This subpart specifies- (1) What States must do to make a satisfactory showing;(2) How the Administrator will determine whether reductions will be imposed; and(3) How the required reductions will be implemented.(c)Scope. The reductions required by this subpart do not apply to-(1) Services provided under a contract with a health maintenance organization; or(2) Facilities in which a QIO is performing medical and utilization reviews under contract with the Medicaid agency in accordance with §431.630 of this chapter.44 FR 56338, 10/1/1979, as amended at 50 FR 15327, 4/17/1985; 51 FR 43198, 12/1/1986