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Medicaid State Plan

Section 1 - Single State Agency Organization

State Plan Submittal Statement

1.1 - Designation and Authority

1.2 - Organization for Administration

1.3 - Statewide Operation

1.4 - State Medical Care Advisory Committee

1.5 - Pediatric Immunization Program

Section 1 - Attachments

1.1 A - Attorney General's Certification

1.1 B - Waivers of the Single State Agency Requirement Granted Under the Intergovernmental Cooperation Act

1.2 A - Organization and Functions of the State Agency

1.2 B - Organization and Functions of the Medical and Child Health Plan Plus Administration Office

1.2 C - Organization and Functions of the Department of Health Care Policy and Financing

1.2 D - Determinations of Eligibility by the Colorado County Departments of Social Services

1.3 A - Statewide Operation

Section 2 - Coverage and Eligibility

2.1 - Application, Determination of Eligibility, and Furnishing Medicaid

2.2 - Coverage and Conditions of Eligibility

2.3 - Residence

2.4 - Blindness

2.5 - Disability

2.6 - Financial Eligibility

2.7 - Medicaid Furnished Out of State

Section 2 - Attachments and Supplements

2.2 A - Groups Covered and Agencies Responsible for Eligibility Determination

Supplement_1 - Reasonable Classifications of Individuals Under the Age of 21, 20, 19 and 18

Supplement_2 - For 1902(f) States More Restrictive Categorical Eligibility Criteria (Non-Financial Criteria)

Supplement_3 - Method for Determining Cost Effectiveness of Caring for Certain Disabled Children at Home

2.6 A - Eligibility Conditions and Requirements

Supplement_1 - Income Eligibility Levels

Supplement_2 - Resource Levels

Supplement_3 - Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered Under Medicaid

Supplement_4 - Methods for Treatment of Income that Differ from Those of the SSI Program

Supplement_5 - More Restrictive Methods of Treating Resources Than Those of the SSI Program

Supplement_6 - Standards for Optional State Supplementary Payments

Supplement_7 - Income Levels for 1902(f) States - Categorically Needy Who Are Covered Under Requirements More Restrictive Than SSI

Supplement_8 - Resource Standards for 1902(f) States - Categorically Needy

Supplement_8a - More Liberal Methods of Treating Income Under Section 1902 (r) (2) of the Act

Supplement_8b - More Liberal Methods of Treating Resources Under Section 1902 (r) (2) or the Act

Supplement_8c - State Long-Term Care Insurance Partnership

Supplement_9 - Transfer of Resources

Supplement_9a - Transfer of Assets

Supplement_9b - Transfer of Assets

Supplement_10 - Consideration of Medicaid Qualifying Trusts - Undue Hardship

Supplement_11 - Cost Effectiveness Methodology for COBRA Continuation Beneficiaries

Supplement_12 - Variations from the Basic Personal Needs Allowance

Supplement_12a -Eligibility Under Section 1931 of the Act

Supplement_13 - Section 1924 Provisions

Supplement_14 - Income and Resource Requirements for Tuberculosis (TB) Infected Individuals

Supplement_17 - Disqulification For Long-Term Care Assistance for Individuals with Substantial Home Equity

Section 3 - Services: General Provisions

3.1 - Amount, Duration, and Scope of Service

3.2 - Coordination of Medicaid with Medicare and Other Insurance

3.3 - Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases

3.4 - Special Requirements Applicable to Sterilization Procedures

3.5 - Families Receiving Extended Medicaid Benefits

3.6 - Unemployed Parent

Section 3 - Attachments and Supplements

3.1_A - Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy

Supplement_1 - Limitations to Care and Services

Supplement_1a - Limitations to Care and Services: Targeted Case Management Services for Persons with a Developmental Disability

Supplement_1b - Limitations to Care and Services: Targeted Case Management Services

Supplement_1c - Limitations to Care and Services: Targeted Case Management Services for Substance Abuse Treatment

Supplement_3 - Limitations to Care and Services - PACE Services

3.1_B - Amount, Duration, and Scope of Services Provided: Medically Needy Groups

3.1_C - Methods and Standards of Assuring High Quality Care

3.1_D - Methods of Assuring Transportation

3.1_E - Standards for the Coverage of Organ Transplant Services

3.1_F Methods and Standards for Voluntary Primary Care Case Management Program

Section 4 - General Program Administration

4.1 - Methods of Administration

4.2 - Hearings for Applicants and Recipients

4.3 - Safeguarding Information on Applicants and Recipients

4.4 - Medicaid Quality Control

4.5 - Medicaid Agency Fraud Detection and Investigation Program

4.6 - Reports

4.7 - Maintenance of Records

4.8 - Availability of Agency Program Manuals

4.9 - Reporting Provider Payments to Internal Revenue Service

4.10 - Free Choice of Providers

4.11 - Relations With Standard-Setting and Survey Agencies

4.12 - Consultation to Medical Facilities

4.13 - Required Provider Agreement

4.14 - Utilization/Quality Control

4.15 - Inspection of Care in Intermediate Care Facilities for the Mentally Retarded, Facilities Providing Inpatient Psychiatric Services for Individuals Under 21, and Mental Hospitals

4.16 - Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees

4.17 - Liens and Adjustments or Recoveries

4.18 - Recipient Cost Sharing and Similar Charges

4.19 - Payment for Services

4.20 - Direct Payments to Certain Recipients for Physicians' or Dentists' Services

4.21 - Prohibition Against Reassignment of Provider Claims

4.22 - Third Party Liability

4.23 - Use of Contracts

4.24 - Standards for Payments for Nursing Facility and Intermediate Care Facility for the Menatlly Retarded Services

4.25 - Program for Licensing Administrators of Nursing Homes

4.26 - Drug Utilization Review Program

4.27 - Disclosure of Survey Information and Provider or Contractor Evaluation

4.28 - Appeals Process

4.29 - Conflict of Interest Provisions

4.30 - Exclusion of Providers and Suspension of Practitioners and Other Individuals

4.31 - Disclosure of Information by Providers and Fiscal Agents

4.32 - Income and Eligibility Verification System

4.33 - Medicaid Eligibility Cards for Homeless Individuals

4.34 - Systematic Alien Verification for Entitlements

4.35 - Enforcement of Compliance for Nursing Facilities

4.36 - Required Coordination Between the Medicaid and WIC Programs

4.38 - Nurse Aide Training and Competency Evaluation for Nursing Facilities

4.39 - Pre-admission Screening and Annual Resident Review in Nursing Facilities

4.40 - Survey & Certification Process

4.41 - Resident Assessment for Nursing Facilities

4.42 - Employee Education About False Claims Recoveries

4.44-Medicaid Prohibition on Payments to Institutions or Enitities Located Outside of the United States

Section 4 - Attachments and Supplements

4.11_A - Standards for Institutions

4.14_B - Multiple Utilization Review Methods for Intermediate Care (ICF/MR) and Nursing Facilities

4.16_A - Medical Assistance Program Relations with the Department of Public Health and Environment

4.17_A - Liens and Adjustments or Recoveries

4.18_A - Charges Imposed on the Categorically Needy

4.18_C - Charges Imposed on the Medically Needy and Other Optional Groups

4.18_D - Premiums Imposed on Low Income Pregnant Women and Infants

4.18_E - Optional Sliding Scale Premiums Imposed on Qualified Disabled and Working Individuals

4.19_A - Methods and Standards for Establishing Prospective Payment Rates - Inpatient Hospital Care

4.19_B - Methods and Standards for Establishing Payment Rates - Other Types of Care

Supplement_1 - Methods and Standards for Establishing Payment Rates - Other Types of Care: Payment of Medicare Part A and Part B Deductible/Coinsurance

4.19_C - Payments for Reserved Beds-Nursing Homes

4.19_D - Methods and Standards for Establishing Payment Rate - Nursing Facility Care

4.19_E - Definition of a Claim-By Type of Service

4.22_A - Requirements for Third Party Liability - Identifying Liable Resources

Supplement_1 - State Laws Requiring Third Parties to Provide Coverage Eligibility and Claims Data

4.22_B - Requirements for Third Party Liability-Payment of Claims

4.22_C - State Method on Cost Effectiveness of Employer-Based Group Health Plans

4.30 - Sanctions for Psychiatric Hospitals

4.32_A - Income and Eligibility Verification System Procedures Requests to Other State Agencies

4.33_A - Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals

4.34_A - Requirements for Advance Directives Under State Plans for Medical Assistance

4.35_A - Enforcement of Compliance for Nursing Home Facilities

4.35_B - Enforcement of Compliance for Nursing Facilities - Termination of Provider Agreement

4.35_C - Enforcement of Compliance for Nursing Facilities - Temporary Management

4.35_D - Enforcement of Compliance for Nursing Facilities - Denial of Payment for New Admissions

4.35_E - Enforcement of Compliance for Nursing Facilities - Civil Money Penalty

4.35_F - Enforcement of Compliance for Nursing Facilities - State Monitoring

4.35_G - Enforcement of Compliance for Nursing Facilities - Transfers of Residents, Transfer of Residents with Closure of Facility

4.35_H - Enforcement of Compliance for Nursing Facilities - Additional Remedies

4.38 - Disclosure of Additional Registry Information

4.38_A - Collection of Additional Registry Information

4.39 - Definition of Specialized Services

4.39_A - Categorical Determinations

4.40_A - Survey and Certification Education Program

4.40_B - Process for the Investigation of Allegations of Resident Neglect and Abuse and Misappropriation of Resident Property

4.40_C - Procedures for Scheduling and Conduct of Standard Surveys

4.40_D - Programs to Measure and Reduce Inconsistency

4.40_E - Process for the Investigation of Complaints and Monitoring

4.42_A - Employee Education About False Claims Recoveries

4.43 - Cooperation with Medicaid Integrity Program Efforts

Section 5 - Personnel Administration

5.1 - Standards of Personnel Administration

5.2 - (Reserved)

5.3 - Training Programs; Subprofessional and Volunteer Programs

Section 6 - Financial Administration

6.1 - Fiscal Policies and Accountability

6.2 - Cost Allocation

6.3 - State Financial Participation

Section 7 - General Provisions

7.1 - Plan Amendments

7.2 - Nondiscrimination

7.4 - State Governor's Review

Section 7 - Attachments

7.2_A - Methods of Administration - Civil Rights