CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS (parts 430 to 456) > PART 438—MANAGED CARE > SUBPART A—General Provisions (§438.1 to §438.12) > 438.8—Provisions that apply to PIHPs and PAHPs.

438.8—Provisions that apply to PIHPs and PAHPs.

(a) The following requirements and options apply to PIHPs, PIHP contracts, and States with respect to PIHPs, to the same extent that they apply to MCOs, MCO contracts, and States for MCOs.
(1) The contract requirements of § 438.6, except for requirements that pertain to HIOs.
(2) The information requirements in § 438.10.
(3) The provision against provider discrimination in § 438.12.
(4) The State responsibility provisions of subpart B of this part except § 438.50.
(5) The enrollee rights and protection provisions in subpart C of this part.
(6) The quality assessment and performance improvement provisions in subpart D of this part to the extent that they are applicable to services furnished by the PIHP.
(7) The grievance system provisions in subpart F of this part.
(8) The certification and program integrity protection provisions set forth in subpart H of this part.
(b) The following requirements and options for PAHPs apply to PAHPs, PAHP contracts, and States.
(1) The contract requirements of § 438.6, except requirements for—
(i) HIOs.
(ii) Advance directives (unless the PAHP includes any of the providers listed in § 489.102) of this chapter.
(2) All applicable portions of the information requirements in § 438.10.
(3) The provision against provider discrimination in § 438.12.
(4) The State responsibility provisions of subpart B of this part except § 438.50.
(5) The provisions on enrollee rights and protections in subpart C of this part.
(6) Designated portions of subpart D of this part.
(7) An enrollee's right to a State fair hearing under subpart E of part 431 of this chapter.
(8) Prohibitions against affiliations with individuals debarred by Federal agencies in § 438.610.
[67 FR 41095, June 14, 2002, as amended at 67 FR 65505, Oct. 25, 2002]