State Medicaid Regulations and Manuals

Prepared February 2008

Arranged alphabetically by state, this document provides the location of many of the key Medicaid regulations and manuals as of the date this document was prepared.

ALABAMA

Alabama Medicaid Agency

ALA. ADMIN. CODE r. 560-X-16 (2007).

Manuals in General:

Provider Manuals:

ALASKA

Department of Health and Social Services – Medical Assistance Program

ALASKA ADMIN. CODE tit. 7 § 43 and § 100 (2007).
Title 7, Part 3, Chapter 43, Articles 1-33.
Title 7, Part 7, Chapter 100, Article 1-15.

Health Care Services Provider Information:

Alaska Medical Assistance through First Health Services Corporation - includes links to provider information including billing manuals and enrollment and other types of forms:

Provider Billing Manuals:

Provider Enrollment Applications:

Provider Enrollment Forms:

ARIZONA

Arizona Health Care Cost Containment System (AHCCCS-pronounced “Access”)

ARIZ. COMP. ADMIN. R. & REGS. 9-22-101 (2007).
Title 9, Ch. 22, Articles. 1-34.

Fee-for-Service Provider Manual:

ARKANSAS

Department of Health and Human Services – Division of Medical Services – Medicaid

016 CODE OF ARK. R. & REGS. § 06-001 (2008). – 016 CODE OF ARK. R. & REGS. §
06-066 (2008).

Pharmacy Provider Manual – 016 CODE OF ARK. R. & REGS. § 06 - 035 (2008).

Provider Documents (arranged by provider type, click on link to specific provider to access additional links to manuals, forms, memorandums, etc.):

CALIFORNIA

California Medical Assistance Program – “Medi-Cal”

CAL. CODE REGS. tit. 22 § 50000–59999 (2007).

Provider Manuals:

COLORADO

Department of Health Care Policy and Financing

10 COLO. CODE REGS. § 2505-10 (2007). – Medical Assistance

3 COLO. CODE REGS. § 719-1. (2007). – Pharmacy Rules and Regulations

Provider Services Manual:

Provider Services Billing Manuals:

CONNECTICUT

Department of Social Services -- Medical Assistance Program

CONN. AGENCIES REGS. § 17 (2008).
CONN. AGENCIES REGS. § 17b (2008).

Publications:

DELAWARE

Department of Health and Social Services – Division of Medicaid & Medical Assistance – Medical Assistance Program

CODE OF DEL. REGS. § 16-5000-5100 (Weil’s 2007).

State of Delaware, Register of Regulations: http://regulations.delaware.gov/services/register.shtml

Title 16, Health and Social Services; 5100 Delaware Social Services Manual:

Pharmacy Provider Manual:

FLORIDA

Department of Children and Families – Agency for Health Care Administration – Medicaid

FLA. ADMIN. CODE ANN. r. 59G-1.001 (2007). – FLA. ADMIN. CODE ANN. r. 59G-13.130 (2007).

Florida Medicaid Provider Handbook and Resource Library:

GEORGIA

Department of Community Health – Division of Medical Assistance

See Georgia Health Partnerships Website for more detailed information concerning Providers

GA. COMP. R. & REGS. r. 350-1 (2007). – GA. COMP. R. & REGS. r. 350-7 (2007).

Georgia Medicaid (Click link at top-center of page for Medicaid Provider Manuals):

HAWAII

Department of Human Services – Med-QUEST Division

CODE OF HAWAII RULES tit. 17 § 1700 (2007). – CODE OF HAWAII RULES tit. 17 §
1746 (2007).
Title 17, Subtitle 12, Chapters 1700-1746

Hawaii Provider Manual:

Med-QUEST Health Plan Manual:

IDAHO

Department of Health & Welfare – Division of Medicaid –“Qualis Health”

16 IDAHO ADMIN. CODE tit. 03 § 03 (2007).
16 IDAHO ADMIN. CODE tit. 03 § 09 (2007).
16 IDAHO ADMIN. CODE tit. 03 § 10 (2007).
16 IDAHO ADMIN. CODE tit. 03 § 17 (2007).
16 IDAHO ADMIN. CODE tit. 03 § 18 (2007).

Idaho Medicaid, Provider Manual: Online
Idaho Medicaid, Provider Manual: PDF

ILLINOIS

Department of Healthcare and Family Services

89 ILL. ADMIN. CODE tit 89, § 10 (2007).
89 ILL. ADMIN. CODE tit 89, § 120 (2007).
89 ILL. ADMIN. CODE tit 89, § 140 (2007).

Illinois Provider Handbooks:

Provider Enrollment:

Pharmacy Information:

INDIANA

Office of the Secretary for Family and Social Services – Indiana Health Coverage Program

405 IND. ADMIN. CODE tit. 405 r. 1 (2007) – 405 IND. ADMIN. CODE tit. 405 r. 8 (2007).

Indiana Provider Manual:

IOWA

Department of Human Services – Iowa Medicaid Enterprise (IME)

IOWA ADMIN. CODE r. 441-75 (2007). – IOWA ADMIN. CODE r. 441-92 (2007).

Iowa Department of Human Services – All Provider Manuals:

KANSAS

Department of Social Services and Kansas Health Policy Authority – Kansas Medical Assistance Program

KAN. ADMIN. REGS. 129-5 (2008). – KAN. ADMIN. REGS. 129-7 (2008).

Kansas Pharmacy Provider Manuals:
(use scroll down box).

KENTUCKY

Cabinet for Health and Family Services – Department for Medicaid Services

907 KY. ADMIN. REGS. 1 (2007). -- 907 KY. ADMIN. REGS. 4 (2007).

Regulations, Statutes, and Material Incorporated by Reference in Administrative Regulations:

Program Manuals and Incorporated Materials:

LOUISIANA

Louisiana Department of Health & Hospitals – Medicaid (Health Services Financing)

LA. REV. STAT. ANN. § 46 (2007).
[Title 46, Chapter 3]
LA. ADMIN. CODE tit. 50 (2007).

Medicaid Publications:

Medicaid Online Manuals for Enrollment and Forms:

Louisiana Provider Manuals:

MAINE

Department of Health and Human Services – Office of MaineCare Services

Code Me. R. § 10-144 (2007).

Manuals:

MaineCare Benefits Manual:

Pharmacy Benefits:

MARYLAND

Department of Health and Mental Hygiene – Medical Care Programs – Medical Assistance Program

MD. REGS. CODE tit 10 § 09 (2008).

Title 10, Subtitle 09,
Especially chapters: 03, 24, 61-75.

Provider Information:

Maryland Medicaid Pharmacy Program:

MASSACHUSETTS

Office of Health and Human Services – MassHealth

MASS. REGS. CODE tit. 130 § 401.000 (2007). – MASS. REGS. CODE tit. 130 § 610.000 (2007).

MassHealth Regulations:

MassHealth Provider Regulations:

MassHealth Member Eligibility Regulations:

MICHIGAN

Department of Community Health -- Medicaid

MICH. ADMIN. CODE r. 338.471a (2007). – MICH. ADMIN. CODE r. 338-484 (2007).

Michigan Medicaid Inquiry, Eligibility & Policy:

Michigan Provider Manual: Online
Michigan Provider Manual: PDF

MINNESOTA

Department of Human Services

MINN. R. 9505 (2007).
MINN. R. 9506 (2007).
Chapters 9505 and 9506.

Manuals:

Health Care Programs Manual:

Minnesota Health Care Program Enrolled Providers: Use scroll down menu to access specific provider sites which include access to provider manuals and other important forms.

Minnesota Health Care Program Enrolled Providers – Provider Manuals:

MISSISSIPPI

Division of Medicaid

CODE OF MISS. RULES 13-000-01 –13-000-033 (2007).
CODE OF MISS. RULES 13-010-001--13-000-023 (2007).

Mississippi Division of Medicaid Provider Policy Manuals:

Billing Manuals:

MISSOURI

Department of Social Services – Division of Medical Services

MO. CODE REGS. tit. 13 § 70-1. (2007). – MO. CODE REGS. tit. 13 § 70-99. (2007).

Missouri Medicaid Provider Participation Links – Link to provider manual located on the left column and page bottom:

Missouri Medicaid Provider Enrollment Information Guide:

MONTANA

Montana Department of Public Health and Human Services – Medicaid

MONT. ADMIN. R. 37.82 (2007).
MONT. ADMIN. R. 37.83 (2007).
MONT. ADMIN. R. 37.85 (2007).
MONT. ADMIN. R. 37.86 (2007).
MONT. ADMIN. R. 37.88 (2007).

“Select your Povider Type”: Provides links to all manuals and agreement and enrollment forms organized by provider type.

NEBRASKA

Nebraska Department of Health and Human Services – Nebraska Medicaid Program

NEB. ADMIN. R. & REGS. 482 (2007).
Title 482, Chapters 1-7 (2007).

Nebraska Medicaid Program Rules and Regulations:

Nebraska Medicaid Program Provider Information -- Provides links to all manuals and agreement and enrollment forms organized by provider type.

NEVADA

Department of Health and Human Services – Division of Health Care Financing and Policy

NEV. ADMIN. CODE ch.428, § 010 (2007). – NEV. ADMIN. CODE ch.428, § 090
(2007).

NEV. ADMIN. CODE ch.422, § 020 (2007). – NEV. ADMIN. CODE ch.428, § 210
(2007).

Nevada Medicaid Homepage: (Links are easily accessed by going to leftmost column of page).

Medicaid Service Manual:

Medicaid State Plan:

Nevada Checkup Manual:

Medicaid Operations Manual:

NEW HAMPSHIRE

New Hampshire Department of Health and Human Services – Office of Medicaid Business & Policy – Medicaid Program

NH. CODE ADMIN. R. He-W 500 (2007).
(See Chapter He-W 500, Parts 501-594).

Law-Rules-Policies:

NEW JERSEY

New Jersey Department of Human Services –Medical Assistance and Health Services – Medicaid Program:

N.J. ADMIN. CODE tit 10 § 71 (2007).
N.J. ADMIN. CODE tit 10 § 72(2007).
N.J. ADMIN. CODE tit 10 § 74 (2007).

Eligibility and Service Manuals:

NEW MEXICO

New Mexico Human Services Department

N.M. ADMIN. CODE tit. 8 §200 (2007).
[Title 8, Chapter 200]

Also see: Chapters 201, 202, 206, 215, 227, 228, 230-235, 240, 242, 243, 245, 248, 249, 250, 252, 259, 262, 280, 281, 285, 290, 300, 301, 302, 305

Medicaid Provider Information: includes Provider Participation Agreement and Billing Instructions

NEW YORK

New York Department of Health – Medicaid

N.Y. COMP. CODES R. & REGS. tit. 18 § 500 (2008). – N.Y. COMP. CODES R. & REGS. tit. 18 § 542 (2008).
Title 18, Chapter II, Subchapter E.

Laws & Regulations:

Medicaid Program Information:

Provider Manuals:

Pharmacy Provider Manual: Online
Pharmacy Provider Manual: PDF

NORTH CAROLINA

Department of Health and Human Services – Division of Medical Assistance

N.C. ADMIN. CODE tit. 10A § 21 (November 2007).
N.C. ADMIN. CODE tit. 10A § 22 (November 2007).

Publications and Reports:

NORTH DAKOTA

Department of Human Services – Medical Assistance Programs – Medicaid

N.D. ADMIN. CODE § 75-02-02-01 (2007). – N.D. ADMIN. CODE § 75-02-02-28
(2007).
N.D. ADMIN. CODE § 75-02-02.1 –01 (2007). – N.D. ADMIN. CODE § 75-02-02.1-42
(2007).
N.D. ADMIN. CODE § 75-02-05-01 (2007). – N.D. ADMIN. CODE § 75-02-05-10
(2007).
Title 75, Article 2, Chapter 2

Medicaid Provider Information:

OHIO

Department of Job and Family Services – Division of Medical Assistance – Medicaid

OHIO ADMIN. CODE § 5101:3 (2007).

Provider Information:

OKLAHOMA

Oklahoma Health Care Authority

OKLA. ADMIN. CODE tit. 317 § § 1, 2, 10, 15, 20, 30, 35, 40, 45 (2007).

Provider: Policies & Rules:

OREGON

Department of Human Services – Health Services – Office of Medical Assistance Programs – Oregon Health Plan

OR. ADMIN. R. 410 (2007).
(Chapter 410, Divisions, 1, 8, 14, 30, 50, 120, 121-125, 127, 129-133, 136-138, 140-143, 145-150)

Data and Publications (information about Ohio Health Plan policies and regulations):

Tools for Providers (contains information regarding rules and guidelines for providers):

PENNSYLVANIA

Pennsylvania Department of Public Welfare – Office of Medical Assistance Programs

55 PA. CODE § 1101 (2007). – 55 Pa. Code § 1251 (2007).
Title 55, Part III

Medical Assistance Regulations:

Medical Assistance Documents:

Forms and Applications:

RHODE ISLAND

Rhode Island Department of Human Services

CODE OF RHODE ISLAND RULES 15-040-001 (Weil’s 2007). – CODE OF RHODE ISLAND RULES 15-040-019 (Weil’s 2007).
(Chapters 001-019)

Rhode Island Dept. of Human Services Code of Rules:

Rules and Regulations:

Proposed Rules and Regulations:

Recently Enacted Rules and Regulations:

SOUTH CAROLINA

South Carolina Department of Health and Human Services

S.C. CODE REGS. 126-300 (2007).– S.C. CODE REGS. 126-399 (2007).
S.C. CODE REGS. 126-500 (2007). – S.C. CODE REGS. 126-570 (2007).
South Carolina Code of Regulations Chapter 126 Articles, 1, 3, 4, 5, 7, and 9.
(Primarily Articles 3 and 5)

Manuals:

Medicaid Providers: (links to all types of providers and important information regarding each provider-type).

SOUTH DAKOTA

Department of Social Services – Medical Assistance Program

S.D. ADMIN. R. 67:16:01 (2007). – ARSD 67:16:47 (2007).
Chapters 1-9, 11-14, 16, 23, 24, 26, 28-29, 31, 33-35, 37-44, 46-47).

Administrative Rules: Covered Medical Services:

Provider Information:

TENNESSEE

Bureau of TennCare

TENN. COMP. R. & REGS. R. 1200-13 (2007).
TENN. COMP. R. & REGS. R. 1240-3 (2007).

Rules for Bureau of TennCare/Medicaid:

TennCare Pharmacy:

TEXAS

Texas Health and Human Services Commission – Medicaid Program

TEX. ADMIN CODE tit. 1 § 315 (2008). – TEX. ADMIN CODE tit. 1 § 394 (2008).
Title 1, Part 15.

Provider Resources:

Program Information:

UTAH

Department of Health – Division of Health Care Financing – Medicaid Program

UTAH ADMIN R. 414-1 (2008). – UTAH ADMIN. R. 414-510 (2008).
See “Health” and section “R414. Health Care Financing, Coverage and Reimbursement Policy”

Utah Medicaid’s Provider’s Guide:

Utah Medicaid Provider Manual:

Enroll as Utah Medicaid Provider:

Manuals for Specific Services:

VERMONT

Agency of Human Services – Office of Vermont Health Access – Medicaid

CODE OF VERMONT RULES 13-170-008 (2007).

Manuals:

Forms:

VIRGINIA

Department of Medical Assistance Services

VIRG. ADMIN. CODE tit. 12 § 30 (2007).
Title 12, Agency 30, Chapters 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 135, 140, 141, 150

Home Page: Provides access to major manuals and handbooks directly.

WASHINGTON

Department of Social and Health Services

WASH. ADMIN. CODE tit. 246 §1 (2007) – WASH. ADMIN. CODE tit. 246 § 97
(2007).
WASH. ADMIN. CODE tit. 388 § 80 (2007). – WASH. ADMIN. CODE tit. 246 § 296
(2007).

Medical Assistance:

Information for Medicaid Providers: