---
kind: "section"
citation: "42 C.F.R. § 431.630"
title: "42"
number: "431.630"
heading: "Coordination of Medicaid with QIOs."
url: "https://uscodex.org/cfr/42/431.630"
---

# §431.630. Coordination of Medicaid with QIOs.

- (a) The State plan may provide for the review of Medicaid services through a contract with a QIO designated under [part 462](/cfr/42/part462.md) of this chapter. Medicaid requirements for medical and utilization review are deemed to be met for those services or providers subject to review under the contract.
- (b) The State plan must provide that the contract with the QIO—
  - (1) Meets the requirements of [§ 434.6(a)](/cfr/42/434.6.md?p=a) of this part;
  - (2) Includes a monitoring and evaluation plan by which the State ensures satisfactory performance by the QIO;
  - (3) Identifies the services and providers subject to QIO review;
  - (4) Ensures that the review activities performed by the QIO are not inconsistent with QIO review activities of Medicare services and includes a description of whether and to what extent QIO determinations will be considered conclusive for Medicaid payment purposes.

## Notes

### Amendments

[50 FR 15327, Apr. 17, 1985]

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 43 FR 45188, Sept. 29, 1978, unless otherwise noted.

### Amendments

[50 FR 15327, Apr. 17, 1985]