U.S. Code of Federal Regulations

Regulations most recently checked for updates: Aug 27, 2025

All TitlesTitle 42Chapter IVPart 457Subpart L - Subpart L—Managed Care

GENERAL PROVISIONS
§ 457.1200 - Basis, scope, and applicability.
§ 457.1201 - Standard contract requirements.
§ 457.1203 - Rate development standards and medical loss ratio.
§ 457.1206 - Non-emergency medical transportation PAHPs.
§ 457.1207 - Information requirements.
§ 457.1208 - Provider discrimination prohibited.
§ 457.1209 - Requirements that apply to MCO, PIHP, PAHP, PCCM, and PCCM entity contracts involving Indians, Indian health care provider (IHCP), and Indian managed care entities (IMCE).

STATE RESPONSIBILITIES
§ 457.1210 - Enrollment process.
§ 457.1212 - Disenrollment.
§ 457.1214 - Conflict of interest safeguards.
§ 457.1216 - Continued services to enrollees.
§ 457.1218 - Network adequacy standards.

ENROLLEE RIGHTS AND PROTECTIONS
§ 457.1220 - Enrollee rights.
§ 457.1222 - Provider-enrollee communication.
§ 457.1224 - Marketing activities.
§ 457.1226 - Liability for payment.
§ 457.1228 - Emergency and poststabilization services.

MCO, PIHP, AND PAHP STANDARDS
§ 457.1230 - Access standards.
§ 457.1233 - Structure and operation standards.

QUALITY MEASUREMENT AND IMPROVEMENT; EXTERNAL QUALITY REVIEW
§ 457.1240 - Quality measurement and improvement.
§ 457.1250 - External quality review.

GRIEVANCE SYSTEM
§ 457.1260 - Grievance system.

SANCTIONS
§ 457.1270 - Sanctions.
§ 457.1280 - Conditions necessary to contract as an MCO, PAHP, or PIHP.
§ 457.1285 - Program integrity safeguards.
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