General Provisions

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Medical Assistance Programs
  6. Managed Care
  7. General Provisions

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Section
438.1

Basis and scope.

Section
438.2

Definitions.

Section
438.3

Standard contract requirements.

Section
438.4

Actuarial soundness.

Section
438.5

Rate development standards.

Section
438.6

Special contract provisions related to payment.

Section
438.7

Rate certification submission.

Section
438.8

Medical loss ratio (MLR) standards.

Section
438.9

Provisions that apply to non-emergency medical transportation PAHPs.

Section
438.10

Information requirements.

Section
438.12

Provider discrimination prohibited.

Section
438.14

Requirements that apply to MCO, PIHP, PAHP, PCCM, and PCCM entity contracts involving Indians, Indian health care providers (IHCPs), and Indian managed care entities (IMCEs).