GENERAL PROVISIONS

• § 457.1200 - Basis, scope, and applicability.

• § 457.1201 - Standard contract requirements.

• § 457.1203 - Rate development standards and medical loss ratio.

• § 457.1206 - Non-emergency medical transportation PAHPs.

• § 457.1207 - Information requirements.

• § 457.1208 - Provider discrimination prohibited.

• § 457.1209 - 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).

STATE RESPONSIBILITIES

• § 457.1210 - Enrollment process.

• § 457.1212 - Disenrollment.

• § 457.1214 -

• § 457.1216 - Continued services to enrollees.

• § 457.1218 - Network adequacy standards.

ENROLLEE RIGHTS AND PROTECTIONS

• § 457.1220 - Enrollee rights.

• § 457.1222 - Provider-enrollee communication.

• § 457.1224 - Marketing activities.

• § 457.1226 - Liability for payment.

• § 457.1228 - Emergency and poststabilization services.

MCO, PIHP, AND PAHP STANDARDS

• § 457.1230 - Access standards.

• § 457.1233 - Structure and operation standards.

QUALITY MEASUREMENT AND IMPROVEMENT; EXTERNAL QUALITY REVIEW

• § 457.1240 - Quality measurement and improvement.

• § 457.1250 - External quality review.

GRIEVANCE SYSTEM

• § 457.1260 - Grievance system.

SANCTIONS

• § 457.1270 - Sanctions.

• § 457.1280 - Conditions necessary to contract as an MCO, PAHP, or PIHP.

• § 457.1285 - Program integrity safeguards.