Under the provisions of federal and state law, Medicaid must establish a mechanism to ensure that all care is of good quality and that the service(s) for which billing was made, conforms to that which was done. See Rule 560-X-2-.01(1) for criteria.

Author: Jacquelyn King, Program Manager; Medical Support

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. S401, et seq.

History: Rule effective October 1, 1982. Amended: Filed January 17, 2012; effective February 21, 2012.