Section 1163.1. Policy

Section 1163.2. Definitions

Section 1163.21. Scope of benefits for the categorically needy

Section 1163.22. Scope of benefits for the medically needy

Section 1163.23. Scope of benefits for State Blind Pension recipients

Section 1163.24. Scope of benefits for General Assistance recipients

Section 1163.31. [Reserved]

Section 1163.32. Hospital units excluded from the DRG prospective payment system

Section 1163.41. General participation requirements

Section 1163.42. [Reserved]

Section 1163.43. Ongoing responsibilities of providers

Section 1163.51. General payment policy

Section 1163.52. Prospective payment methodology

Section 1163.52a. Assignment of DRG—statement of policy

Section 1163.53. [Reserved]

Section 1163.53a. Prospective capital reimbursement system

Section 1163.54. [Reserved]

Section 1163.55. Payments for direct medical education for Fiscal Years 1993-94 and 1994-95

Section 1163.56. Outliers

Section 1163.57. Payment policy for readmissions

Section 1163.58. Payment policy for transfers

Section 1163.59. Noncompensable services, items and outlier days

Section 1163.59a. Utilization guidelines for inpatient hospital drug and alcohol services under the MA Program—statement of policy

Section 1163.60. Payment conditions for sterilizations

Section 1163.61. Payment conditions for hysterectomies

Section 1163.62. Payment conditions for abortions

Section 1163.63. Billing requirements

Section 1163.64. Cost reports

Section 1163.65. Payment for out-of-State hospital services

Section 1163.66. Third-party liability

Section 1163.67. Disproportionate share payments

Section 1163.70. Changes of ownership or control

Section 1163.71. Scope of utilization review process

Section 1163.72. Utilization review: general

Section 1163.73. Hospital utilization review plan

Section 1163.74. Requirements for hospital utilization review committees

Section 1163.75. Responsibilities of the hospital utilization review committee

Section 1163.76. Plan of care

Section 1163.77. Admission review requirements

Section 1163.78. [Reserved]

Section 1163.78a. Review requirements for day outliers

Section 1163.78b. Review requirements for cost outliers

Section 1163.79. Medical Care Evaluation studies

Section 1163.80. Adverse determinations

Section 1163.81. [Reserved]

Section 1163.91. Provider misutilization

Section 1163.92. Administrative sanctions

Section 1163.101. Provider right to appeal

Section 1163.121. [Reserved]

Section 1163.122. Determination of DRG relative values

Section 1163.123. [Reserved]

Section 1163.124. [Reserved]

Section 1163.125. [Reserved]

Section 1163.126. Computation of hospital specific base payment rates

Section 1163.127. [Reserved]