§457.950. Contract and payment requirements including certification of payment-related information.
42 C.F.R. § 457.950
MCOs, PAHPs, PIHPs, PCCMs, and PCCM entities. The contract requirements for MCOs, PAHPs, PIHPs, PCCMs, and PCCM entities are provided in § 457.1201.
Fee-for-service entities. A State that makes payments to fee-for-service entities under a separate child health program must—
Establish procedures to ensure that the entity certifies and attests that information on claim forms is truthful, accurate, and complete;
Ensure that fee-for-service entities understand that payment and satisfaction of the claims will be from Federal and State funds, and that any false claims may be prosecuted under applicable Federal or State laws; and
Require, as a condition of participation, that fee-for-service entities provide the State, CMS and/or the HHS Office of the Inspector General with access to enrollee health claims data, claims payment data and related records.
Notes, amendments, and revision history
Amendments
[66 FR 2685, Jan. 11, 2001, as amended at 81 FR 27897, May 6, 2016]
Source
Source: 66 FR 2685, Jan. 11, 2001, unless otherwise noted.
Authority
Authority: 42 U.S.C. 1302.
Source
Source: 65 FR 33622, May 24, 2000, unless otherwise noted.
Amendments
[66 FR 2685, Jan. 11, 2001, as amended at 81 FR 27897, May 6, 2016]