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USA-USCODE-2024-T42-XVIII, 42 USC 1395kk-1(a)(1) to (4). https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "locator": "USA-USCODE-2024-T42-XVIII, 42 USC 1395kk-1(a)(1) to (4)", "locator_text": "USA-USCODE-2024-T42-XVIII, 42 USC 1395kk-1(a)(1) to (4)" } ], "proposed_statement": "The Secretary may contract with eligible entities as Medicare administrative contractors for specified payment, provider-service, and beneficiary-service functions.", "evidence_excerpt": null, "excerpt_status": "not_displayed", "direct_text_checkable": false, "verification_route": "open_source_at_displayed_locator", "evidence_mode_candidate": "formal", "territory_scope": "Federal", "period_basis": "Same", "verification_requirements": [ "Acquire current contract jurisdictions, awards, functions, and subcontractors." ], "display_status": "shown_in_full", "review_channel": "text_anchored_annotation" }, { "display_evidence_id": "display-evidence:USA:e4d473966af739edc440", "country_id": "USA", "record_type": "candidate_fact", "display_eligible": true, "evidence_source_layer": "country_source_locator", "coverage_domains": [ "facility_organization", "hospital_organization", "ownership_boundary" ], "source_references": [ { "source_reference_id": "display-source:701ba8ab5b9d96acdf49", "title": "CMS Hospital General Information", "url": "https://data.cms.gov/provider-data/dataset/xubh-q36u", "citation": "CMS Hospital General Information. 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The source supports a formal rule context, not a finding that data exchange or prior authorization has already improved for patients or providers.", "tags": [], "territory": "United States; payer types and compliance dates specified in CMS-0057-F", "title": "Interoperability-rule compliance context", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f" } ] }, { "analytical_mapping": { "mapping_basis": "reported_from_official_programme_resource_page", "mapping_group": "decision_rights_and_autonomy", "mapping_id": "candidate-mapping:USA:decision-autonomy:managed-care-resource-boundary", "source_projection_ids": [ "country-improvement-source:USA:medicaid-managed-care" ], "support_state": "candidate_supported", "target_slot": "federal-managed-care-resource-boundary", "target_view": "decisions", "typed_fields": { "autonomy_boundary": "It does not classify provider or plan autonomy.", "decision_boundary": "The landing page is not a decision-rights matrix.", "reported_resource": "Federal managed-care and state technical-assistance resources" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Medicaid.gov, Managed Care, retrieved 2026-08-22.", "country_ids": [ "USA" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "market_structure" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Page title; Resources for States and Medicaid State Technical Assistance navigation." }, "material_id": "material:2d3ba6525c5383b6e083df25", "notes": [ "Keep the difference between a resource page and a decision-rights analysis explicit." ], "origin": "candidate-analytical-mappings", "period": "Agency resource page retrieved 2026-08-22", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "029a87e6d57241885d8fa92719afe3a0b9cd7d3292ec04a04e3f296b9d21d9f7" }, "statement": "CMS's managed-care landing page identifies federal programme resources and state technical-assistance material. It does not establish a national allocation of state, plan, or provider decisions.", "tags": [], "territory": "United States Medicaid programme; state implementation context", "title": "Managed-care resource boundary", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.medicaid.gov/medicaid/managed-care/index.html" } ] }, { "analytical_mapping": { "mapping_basis": "reported_from_official_medicare_payment_programme_pages", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:USA:relationships-networks:medicare-payment-resources", "source_projection_ids": [ "country-improvement-source:USA:cms-acute-inpatient-pps", "country-improvement-source:USA:cms-physician-fee-schedule" ], "support_state": "candidate_supported", "target_slot": "medicare-payer-and-provider-payment-resource-boundary", "target_view": "public-private", "typed_fields": { "boundary": "The pages do not provide provider ownership, market share, or all-payer contracting relationships.", "payer_context": "CMS Medicare fee-for-service payment programme resources", "provider_context": "Acute inpatient and professional-service programme pages" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "CMS, Acute Inpatient PPS and Physician Fee Schedule, retrieved 2026-08-22.", "country_ids": [ "USA" ], "coverage_domains": [ "actors", "government_responsibilities", "hospital_organization", "market_structure", "ownership", "primary_care" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Acute Inpatient PPS and Physician Fee Schedule page titles and programme links." }, "material_id": "material:da719f42e45ec8c46613d168", "notes": [ "Do not interpret payment-programme pages as a public-private ownership or competition census." ], "origin": "candidate-analytical-mappings", "period": "CMS programme pages retrieved 2026-08-22", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "12ad999b2308abf221f5ce8ea1ade66b953f20a2d5b836e62a4e82a19fed4bb6" }, "statement": "CMS maintains separate Medicare payment-programme resources for acute inpatient services and physician fee schedule services. These sources do not establish provider ownership, private-sector share, or all-payer purchasing relationships.", "tags": [], "territory": "United States Medicare payment-programme scope", "title": "Medicare payment-resource context", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps" }, { "kind": "source_reference", "source": "Physician Fee Schedule", "url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched" } ] }, { "analytical_mapping": { "mapping_basis": "bounded_from_official_payment_resource_page", "mapping_group": "decision_rights_and_autonomy", "mapping_id": "candidate-mapping:USA:decision-autonomy:provider-autonomy-not-classified", "source_projection_ids": [ "country-improvement-source:USA:cms-physician-fee-schedule" ], "support_state": "candidate_supported", "target_slot": "physician-fee-schedule-autonomy-boundary", "target_view": "autonomy", "typed_fields": { "authority_evidence": "The source is a Medicare payment-resource page.", "autonomy_boundary": "It does not classify workforce, financial, procurement, capital, operations, or service-mix autonomy.", "scope": "No all-payer or provider-level autonomy conclusion is supported." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "CMS, Physician Fee Schedule, retrieved 2026-08-22.", "country_ids": [ "USA" ], "coverage_domains": [ "autonomy", "decision_rights", "government_responsibilities", "hospital_organization", "primary_care" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Physician Fee Schedule page, title and care-management resource paragraph." }, "material_id": "material:e5b779c21a5cbb084334e397", "notes": [ "Do not display the bounded absence of an autonomy classification as a substantive provider-autonomy finding." ], "origin": "candidate-analytical-mappings", "period": "CMS programme page retrieved 2026-08-22", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "89cf9a83acec046e10e1cd622df3eb85fcdf63c5d55cd34f986fd5e5f4bcdee8" }, "statement": "The cited Physician Fee Schedule page is a Medicare payment-programme resource, not a provider-autonomy assessment. It does not support a classification of primary-care or hospital authority over operations or financial management.", "tags": [], "territory": "United States Medicare physician and other professional service payment context", "title": "Provider-autonomy evidence boundary", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A CMS hospital row cannot by itself establish a legal owner, asset owner, operating company, state license, corporate family, network contract, or every physical care site.", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Metadata description, CSV schema, and absent relationship fields" }, "material_id": "material:0b24f3324cd4269b4f211325", "notes": [ "Join authoritative corporate, license, enrollment, ownership, contract, and site sources." ], "origin": "candidate-claims", "period": "Frozen source scope", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": {}, "statement": "A CMS hospital row cannot by itself establish a legal owner, asset owner, operating company, state license, corporate family, network contract, or every physical care site.", "tags": [], "territory": "Federal", "title": "A CMS hospital row cannot by itself establish a legal owner, asset owner, operating company, state license, corporate family, network contract, or every physical care site.", "urls": [] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(b)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:e8d295076eed95ec843fa078", "notes": [ "An assurance is not observed proof of network adequacy.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.", "tags": [], "territory": "Federal", "title": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:bcab71c7646ec5c909e0f0f1", "notes": [ "Acquire California's current approved page, statute, organization, and delegation instruments.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.", "tags": [], "territory": "Federal", "title": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicaid state plan must operate in all political subdivisions of the state and be mandatory on them if they administer it.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "`USA-USCODE-2024-T42-XIX`, 42 USC 1396a(a)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:d6d4559f2511bb4d78006256", "notes": [ "Verify later law and the selected state's administrative structure.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "2024 annual edition", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid state plan must operate in all political subdivisions of the state and be mandatory on them if they administer it.", "tags": [], "territory": "Federal", "title": "A Medicaid state plan must operate in all political subdivisions of the state and be mandatory on them if they administer it.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicare Advantage plan cannot be elected or paid without a federal contract with its organization under section 1395w-27.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-27(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:c9cdfa432d4122e294be0720", "notes": [ "Acquire the current contract, plan benefit package, service area, network, and effective period.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "A Medicare Advantage plan cannot be elected or paid without a federal contract with its organization under section 1395w-27.", "tags": [], "territory": "Federal", "title": "A Medicare Advantage plan cannot be elected or paid without a federal contract with its organization under section 1395w-27.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicare Advantage plan is linked to a geographic service area and enrollment generally depends on residence in that area.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-21(b)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:82ac14a6eaae7646172442a0", "notes": [ "Acquire current plan service-area data and exceptions.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "A Medicare Advantage plan is linked to a geographic service area and enrollment generally depends on residence in that area.", "tags": [], "territory": "Federal", "title": "A Medicare Advantage plan is linked to a geographic service area and enrollment generally depends on residence in that area.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(c)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:d53024bd54227c87c2300023", "notes": [ "Acquire current 42 CFR Part 438 rules, California strategy, external review, and findings.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.", "tags": [], "territory": "Federal", "title": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A state health or other appropriate medical agency has specified responsibility for health standards for institutions where Medicaid recipients may receive care.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(9) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:a6766f2eb7a72a2ec10a9c78", "notes": [ "Separate Medicaid participation standards from state facility licensing.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A state health or other appropriate medical agency has specified responsibility for health standards for institutions where Medicaid recipients may receive care.", "tags": [], "territory": "Federal", "title": "A state health or other appropriate medical agency has specified responsibility for health standards for institutions where Medicaid recipients may receive care.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A state may require eligible people to enroll with a managed-care entity when the entity, state contract, and statutory safeguards meet the applicable requirements.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(a)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:99208bf2706119944ac35619", "notes": [ "Verify population, state authority, waiver, contract, service area, and effective period.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A state may require eligible people to enroll with a managed-care entity when the entity, state contract, and statutory safeguards meet the applicable requirements.", "tags": [], "territory": "Federal", "title": "A state may require eligible people to enroll with a managed-care entity when the entity, state contract, and statutory safeguards meet the applicable requirements.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "An eligible person may elect original Medicare or an available Medicare Advantage plan under the statutory conditions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-21(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:b911277d1d7bc1dadae0345d", "notes": [ "Verify current terminology, eligibility, plan availability, and regulations.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "An eligible person may elect original Medicare or an available Medicare Advantage plan under the statutory conditions.", "tags": [], "territory": "Federal", "title": "An eligible person may elect original Medicare or an available Medicare Advantage plan under the statutory conditions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "CMS metadata describes Hospital General Information as a list of hospitals registered with Medicare and reports a 13 May 2026 release.. https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/xubh-q36u", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "USA-CMS-HOSPITAL-METADATA`, dataset `xubh-q36u | Public authoritative source: https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/xubh-q36u" }, "material_id": "material:53771906d5fb5e99eabd0562", "notes": [ "Acquire dataset methodology, update policy, and registration-status semantics.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Metadata released 2026-05-13", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/json", "response_sha256": "31eea397b8bfe8207168cefda23256eb9cb3d5e49158d221eda8465a2d8e5f8c" }, "statement": "CMS metadata describes Hospital General Information as a list of hospitals registered with Medicare and reports a 13 May 2026 release.", "tags": [], "territory": "Federal", "title": "CMS metadata describes Hospital General Information as a list of hospitals registered with Medicare and reports a 13 May 2026 release.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/xubh-q36u" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Except where Title XVIII provides otherwise, the HHS Secretary administers Medicare and may perform functions directly or by contract.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "`USA-USCODE-2024-T42-XVIII`, 42 USC 1395kk(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:9734ee334596bf9da6a0e802", "notes": [ "Verify later law and current internal delegation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "2024 annual edition", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "Except where Title XVIII provides otherwise, the HHS Secretary administers Medicare and may perform functions directly or by contract.", "tags": [], "territory": "Federal", "title": "Except where Title XVIII provides otherwise, the HHS Secretary administers Medicare and may perform functions directly or by contract.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Federal Medicaid payments are made to states with approved plans according to statutory matching and administrative formulas.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396b(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:e8d858f92ab39da5a19a498b", "notes": [ "Acquire current federal matching rates, state expenditures, and reconciliation records.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "Federal Medicaid payments are made to states with approved plans according to statutory matching and administrative formulas.", "tags": [], "territory": "Federal", "title": "Federal Medicaid payments are made to states with approved plans according to statutory matching and administrative formulas.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "For the section 1396u-2 framework, a managed-care entity is a Medicaid managed-care organization or primary care case manager meeting the incorporated definitions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(a)(1)(B) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:3fe11f954bd778b8788464fe", "notes": [ "Preserve organization, plan product, subcontractor, network, and provider as distinct entities.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "For the section 1396u-2 framework, a managed-care entity is a Medicaid managed-care organization or primary care case manager meeting the incorporated definitions.", "tags": [], "territory": "Federal", "title": "For the section 1396u-2 framework, a managed-care entity is a Medicaid managed-care organization or primary care case manager meeting the incorporated definitions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(23) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:5461ab4b5d889c85ad2b0c26", "notes": [ "Never label a population free-choice or managed-care without its state authority and enrollment category.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.", "tags": [], "territory": "Federal", "title": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395cc(a)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:94df9d4ad99d19216c4bc01b", "notes": [ "Map provider type, agreement status, enrollment, certification, and sanctions separately.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.", "tags": [], "territory": "Federal", "title": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(30)(A) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:1560eb48d2f26921c27b9ed2", "notes": [ "Payment belongs in the Payment knob; observed access requires current data and litigation or compliance review.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.", "tags": [], "territory": "Federal", "title": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2 amendment of subsection (a)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:ece0898072b127cbffc83e8f", "notes": [ "Verify current incorporated text, later amendments, federal rules, and state implementation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Effective-date note in 2024 edition", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.", "tags": [], "territory": "Federal", "title": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The Secretary has statutory authority to terminate a Medicare Advantage organization contract under specified conditions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-27(c)(2) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:75861d73cc38f9eb16ac3d6d", "notes": [ "Review notice, appeal, regulation, and current enforcement records.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "The Secretary has statutory authority to terminate a Medicare Advantage organization contract under specified conditions.", "tags": [], "territory": "Federal", "title": "The Secretary has statutory authority to terminate a Medicare Advantage organization contract under specified conditions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The Secretary may contract with eligible entities as Medicare administrative contractors for specified payment, provider-service, and beneficiary-service functions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395kk-1(a)(1) to (4) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:b332565327d5c14990a76ca9", "notes": [ "Acquire current contract jurisdictions, awards, functions, and subcontractors.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "The Secretary may contract with eligible entities as Medicare administrative contractors for specified payment, provider-service, and beneficiary-service functions.", "tags": [], "territory": "Federal", "title": "The Secretary may contract with eligible entities as Medicare administrative contractors for specified payment, provider-service, and beneficiary-service functions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The Secretary must enter qualifying agreements to use willing state or local agencies for specified Medicare provider survey and certification functions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395aa(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:1f3adf03ca1ed8def60e0112", "notes": [ "Review provider-type scope, accreditation alternatives, and current agreements.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "The Secretary must enter qualifying agreements to use willing state or local agencies for specified Medicare provider survey and certification functions.", "tags": [], "territory": "Federal", "title": "The Secretary must enter qualifying agreements to use willing state or local agencies for specified Medicare provider survey and certification functions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The acquired Title XVIII and XIX texts are 2024 annual Code editions and cannot alone establish the law in force on 10 August 2026.", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Both GovInfo 2024 packages and excluded 2025 not-found artifacts" }, "material_id": "material:f4e2edabc109614f1ffac7cb", "notes": [ "Check all later public laws, current Compilation pages, regulations, and effective dates." ], "origin": "candidate-claims", "period": "2024 edition versus 2026 snapshot", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": {}, "statement": "The acquired Title XVIII and XIX texts are 2024 annual Code editions and cannot alone establish the law in force on 10 August 2026.", "tags": [], "territory": "Federal", "title": "The acquired Title XVIII and XIX texts are 2024 annual Code editions and cannot alone establish the law in force on 10 August 2026.", "urls": [] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The dataset exposes facility name, address, hospital type, a reported hospital-ownership category, emergency-services status, and selected measures.. https://data.cms.gov/provider-data/sites/default/files/data_dictionaries/hospital/HOSPITAL_Data_Dictionary.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Same CSV header and dictionary `Hospital General Information` table | Public authoritative source: https://data.cms.gov/provider-data/sites/default/files/data_dictionaries/hospital/HOSPITAL_Data_Dictionary.pdf" }, "material_id": "material:f1b3b5c2fa8e8e250b9bc175", "notes": [ "Validate null codes, category definitions, temporal meaning, and change history." ], "origin": "candidate-claims", "period": "April and May 2026 files", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": {}, "statement": "The dataset exposes facility name, address, hospital type, a reported hospital-ownership category, emergency-services status, and selected measures.", "tags": [], "territory": "Federal", "title": "The dataset exposes facility name, address, hospital type, a reported hospital-ownership category, emergency-services status, and selected measures.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://data.cms.gov/provider-data/sites/default/files/data_dictionaries/hospital/HOSPITAL_Data_Dictionary.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The federal managed-care framework generally requires a choice of at least two qualifying entities, subject to stated rural and other rules.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(a)(3) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:8a385df611ac291b7f97aef4", "notes": [ "Verify current exceptions and California county model.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The federal managed-care framework generally requires a choice of at least two qualifying entities, subject to stated rural and other rules.", "tags": [], "territory": "Federal", "title": "The federal managed-care framework generally requires a choice of at least two qualifying entities, subject to stated rural and other rules.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The frozen CSV contains 5,432 rows and 5,432 unique six-character facility IDs.. https://data.cms.gov/provider-data/dataset/xubh-q36u", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": null, "institution": null, "locator": { "description": "`USA-CMS-HOSPITAL-CSV-2026-05-13`, full-file row and first-field derivation | Public authoritative source: https://data.cms.gov/provider-data/dataset/xubh-q36u" }, "material_id": "material:73dcc6135a697dcda4656a07", "notes": [ "Store script, hash, exclusions, and leading-zero preservation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Frozen 2026-05-13 distribution", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "11612c367d9de8eaa47ad3b9cda178477e7fc9e12a30113d0e52b3eb029a7ab2" }, "statement": "The frozen CSV contains 5,432 rows and 5,432 unique six-character facility IDs.", "tags": [], "territory": "Federal", "title": "The frozen CSV contains 5,432 rows and 5,432 unique six-character facility IDs.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://data.cms.gov/provider-data/dataset/xubh-q36u" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(6) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:4000992a7d96901710703791", "notes": [ "Acquire current reporting regulations and California submissions.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.", "tags": [], "territory": "Federal", "title": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(33)(B) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:7825abda035541a066e14193", "notes": [ "Map the selected state's agency split and current survey agreements.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.", "tags": [], "territory": "Federal", "title": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(22) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:4732dfa35d004e232e5dcbc2", "notes": [ "Acquire the selected state's approved state-plan pages and amendments.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claims", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_claim", "record_kind_label": "Candidate Claim", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.", "tags": [], "territory": "Federal", "title": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A CMS hospital row cannot by itself establish a legal owner, asset owner, operating company, state license, corporate family, network contract, or every physical care site.", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Metadata description, CSV schema, and absent relationship fields" }, "material_id": "material:bdd010d56fb1467691c5be1c", "notes": [ "Requires source-version registration and reviewer annotation." ], "origin": "candidate-evidence", "period": "Frozen source scope", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": {}, "statement": "A CMS hospital row cannot by itself establish a legal owner, asset owner, operating company, state license, corporate family, network contract, or every physical care site.", "tags": [], "territory": "Federal", "title": "A CMS hospital row cannot by itself establish a legal owner, asset owner, operating company, state license, corporate family, network contract, or every physical care site.", "urls": [] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(b)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:3c717f6ed043b254c98af964", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true, "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.", "tags": [], "territory": "Federal", "title": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:bd2c7678b9dfb77886eb4356", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true, "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.", "tags": [], "territory": "Federal", "title": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": 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414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.", "tags": [], "territory": "Federal", "title": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A state health or other appropriate medical agency has specified responsibility for health standards for institutions where Medicaid recipients may receive 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"analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "For the section 1396u-2 framework, a managed-care entity is a Medicaid managed-care organization or primary care case manager meeting the incorporated definitions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(a)(1)(B) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:9558a645e946ad5e172391ae", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true, "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "For the section 1396u-2 framework, a managed-care entity is a Medicaid managed-care organization or primary care case manager meeting the incorporated definitions.", "tags": [], "territory": "Federal", "title": "For the section 1396u-2 framework, a managed-care entity is a Medicaid managed-care organization or primary care case manager meeting the incorporated definitions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(23) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": 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program, provider, and territorial exceptions.", "tags": [], "territory": "Federal", "title": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395cc(a)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:c96778d2e3d352ea552381e4", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true, "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.", "tags": [], "territory": "Federal", "title": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(30)(A) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:fed744b472c835e2005a8db3", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, 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{ "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2 amendment of subsection (a)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:3974ab1f1206bfd7bba08599", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Effective-date note in 2024 edition", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true, "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.", "tags": [], "territory": "Federal", "title": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The Secretary has statutory authority to terminate a Medicare Advantage organization contract under specified conditions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-27(c)(2) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:b57db6c3447c403adcebcc2b", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true, "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "The Secretary has statutory authority to terminate a Medicare Advantage organization contract under specified conditions.", "tags": [], "territory": "Federal", "title": "The 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https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:a5dd6889e1b71c08a6febf84", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true, "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "The Secretary may contract with eligible entities as Medicare administrative contractors for specified payment, provider-service, and beneficiary-service functions.", "tags": [], "territory": "Federal", "title": "The Secretary may contract with eligible entities as Medicare administrative contractors for specified payment, provider-service, and beneficiary-service functions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The Secretary must enter qualifying agreements to use willing state or local agencies for specified Medicare provider survey and certification functions.. 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"annotation_status": "open", "authors": [], "availability": {}, "citation": "The acquired Title XVIII and XIX texts are 2024 annual Code editions and cannot alone establish the law in force on 10 August 2026.", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Both GovInfo 2024 packages and excluded 2025 not-found artifacts" }, "material_id": "material:435a2e55e4f90a62f2b73e1f", "notes": [ "Requires source-version registration and reviewer annotation." ], "origin": "candidate-evidence", "period": "2024 edition versus 2026 snapshot", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "triage_status": "new" }, 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"application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.", "tags": [], "territory": "Federal", "title": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(33)(B) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:1ecd3a080d56f2b148621fe4", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true, "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.", "tags": [], "territory": "Federal", "title": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(22) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:bbd8b04b1f9f5f6ddf8e4e7d", "notes": [ "Requires source-version registration and reviewer annotation.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-evidence", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "candidate_evidence_statement", "record_kind_label": "Candidate Evidence Statement", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "review_status": "needs_review", "source_version_linked_from_country_score_acquisition": true, "triage_status": "new" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.", "tags": [], "territory": "Federal", "title": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A CMS hospital row cannot by itself establish a legal owner, asset owner, operating company, state license, corporate family, network contract, or every physical care site.", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Metadata description, CSV schema, and absent relationship fields" }, "material_id": "material:8029ebe0e94e6d32e75e0eca", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Join authoritative corporate, license, enrollment, ownership, contract, and site sources.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence." ], "origin": "candidate-claim-qa-queue", "period": "Frozen source scope", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": {}, "statement": "A CMS hospital row cannot by itself establish a legal owner, asset owner, operating company, state license, corporate family, network contract, or every physical care site.", "tags": [], "territory": "Federal", "title": "A CMS hospital row cannot by itself establish a legal owner, asset owner, operating company, state license, corporate family, network contract, or every physical care site.", "urls": [] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(b)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:bcdd7b679c547ef5b8e53af5", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "An assurance is not observed proof of network adequacy.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.", "tags": [], "territory": "Federal", "title": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:93cdbf5fd14f1646923a4522", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Acquire California's current approved page, statute, organization, and delegation instruments.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "multiple_predicate_markers", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.", "tags": [], "territory": "Federal", "title": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicaid state plan must operate in all political subdivisions of the state and be mandatory on them if they administer it.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "`USA-USCODE-2024-T42-XIX`, 42 USC 1396a(a)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:2ac990d0fd027c443710e853", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Verify later law and the selected state's administrative structure.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "multiple_predicate_markers", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "2024 annual edition", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid state plan must operate in all political subdivisions of the state and be mandatory on them if they administer it.", "tags": [], "territory": "Federal", "title": "A Medicaid state plan must operate in all political subdivisions of the state and be mandatory on them if they administer it.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicare Advantage plan cannot be elected or paid without a federal contract with its organization under section 1395w-27.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-27(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:5c36dfee1240098cf30e04e2", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Acquire the current contract, plan benefit package, service area, network, and effective period.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "A Medicare Advantage plan cannot be elected or paid without a federal contract with its organization under section 1395w-27.", "tags": [], "territory": "Federal", "title": "A Medicare Advantage plan cannot be elected or paid without a federal contract with its organization under section 1395w-27.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A Medicare Advantage plan is linked to a geographic service area and enrollment generally depends on residence in that area.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-21(b)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:0c7c1bcc4d332c8ee214be6d", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Acquire current plan service-area data and exceptions.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "A Medicare Advantage plan is linked to a geographic service area and enrollment generally depends on residence in that area.", "tags": [], "territory": "Federal", "title": "A Medicare Advantage plan is linked to a geographic service area and enrollment generally depends on residence in that area.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(c)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:4f332e684ad8540159ea1252", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Acquire current 42 CFR Part 438 rules, California strategy, external review, and findings.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "while_clause_boundary", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.", "tags": [], "territory": "Federal", "title": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A state health or other appropriate medical agency has specified responsibility for health standards for institutions where Medicaid recipients may receive care.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(9) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:ac804cce94a0da972d8fed60", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Separate Medicaid participation standards from state facility licensing.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A state health or other appropriate medical agency has specified responsibility for health standards for institutions where Medicaid recipients may receive care.", "tags": [], "territory": "Federal", "title": "A state health or other appropriate medical agency has specified responsibility for health standards for institutions where Medicaid recipients may receive care.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "A state may require eligible people to enroll with a managed-care entity when the entity, state contract, and statutory safeguards meet the applicable requirements.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(a)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:5396579d601292900ed09063", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Verify population, state authority, waiver, contract, service area, and effective period.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A state may require eligible people to enroll with a managed-care entity when the entity, state contract, and statutory safeguards meet the applicable requirements.", "tags": [], "territory": "Federal", "title": "A state may require eligible people to enroll with a managed-care entity when the entity, state contract, and statutory safeguards meet the applicable requirements.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "An eligible person may elect original Medicare or an available Medicare Advantage plan under the statutory conditions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-21(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:79e5d181cd8f2fa96a6e9fb4", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Verify current terminology, eligibility, plan availability, and regulations.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "An eligible person may elect original Medicare or an available Medicare Advantage plan under the statutory conditions.", "tags": [], "territory": "Federal", "title": "An eligible person may elect original Medicare or an available Medicare Advantage plan under the statutory conditions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "CMS metadata describes Hospital General Information as a list of hospitals registered with Medicare and reports a 13 May 2026 release.. https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/xubh-q36u", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "USA-CMS-HOSPITAL-METADATA`, dataset `xubh-q36u | Public authoritative source: https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/xubh-q36u" }, "material_id": "material:2d1cda8e1f11089368330268", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Acquire dataset methodology, update policy, and registration-status semantics.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Metadata released 2026-05-13", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/json", "response_sha256": "31eea397b8bfe8207168cefda23256eb9cb3d5e49158d221eda8465a2d8e5f8c" }, "statement": "CMS metadata describes Hospital General Information as a list of hospitals registered with Medicare and reports a 13 May 2026 release.", "tags": [], "territory": "Federal", "title": "CMS metadata describes Hospital General Information as a list of hospitals registered with Medicare and reports a 13 May 2026 release.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/xubh-q36u" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Except where Title XVIII provides otherwise, the HHS Secretary administers Medicare and may perform functions directly or by contract.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "`USA-USCODE-2024-T42-XVIII`, 42 USC 1395kk(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:57ad93a26bde6f47f7f1b84c", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Verify later law and current internal delegation.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "multiple_predicate_markers", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "2024 annual edition", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "Except where Title XVIII provides otherwise, the HHS Secretary administers Medicare and may perform functions directly or by contract.", "tags": [], "territory": "Federal", "title": "Except where Title XVIII provides otherwise, the HHS Secretary administers Medicare and may perform functions directly or by contract.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Federal Medicaid payments are made to states with approved plans according to statutory matching and administrative formulas.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396b(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:a2b6cc3f086c053cde06e325", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Acquire current federal matching rates, state expenditures, and reconciliation records.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "Federal Medicaid payments are made to states with approved plans according to statutory matching and administrative formulas.", "tags": [], "territory": "Federal", "title": "Federal Medicaid payments are made to states with approved plans according to statutory matching and administrative formulas.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "For the section 1396u-2 framework, a managed-care entity is a Medicaid managed-care organization or primary care case manager meeting the incorporated definitions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(a)(1)(B) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:32fa6df5467a863d4a2919b5", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Preserve organization, plan product, subcontractor, network, and provider as distinct entities.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "For the section 1396u-2 framework, a managed-care entity is a Medicaid managed-care organization or primary care case manager meeting the incorporated definitions.", "tags": [], "territory": "Federal", "title": "For the section 1396u-2 framework, a managed-care entity is a Medicaid managed-care organization or primary care case manager meeting the incorporated definitions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(23) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:1c6460704a668eac4ffac3a3", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Never label a population free-choice or managed-care without its state authority and enrollment category.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.", "tags": [], "territory": "Federal", "title": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395cc(a)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:4e85389518152dbff984b728", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Map provider type, agreement status, enrollment, certification, and sanctions separately.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.", "tags": [], "territory": "Federal", "title": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(30)(A) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:2873074bd86acbbaad1165ee", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Payment belongs in the Payment knob; observed access requires current data and litigation or compliance review.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.", "tags": [], "territory": "Federal", "title": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2 amendment of subsection (a)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:3b71cf49ff661dbbca2a2589", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Verify current incorporated text, later amendments, federal rules, and state implementation.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Effective-date note in 2024 edition", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.", "tags": [], "territory": "Federal", "title": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The Secretary has statutory authority to terminate a Medicare Advantage organization contract under specified conditions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-27(c)(2) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:d267f36a9406d4a46bb3977c", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Review notice, appeal, regulation, and current enforcement records.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "The Secretary has statutory authority to terminate a Medicare Advantage organization contract under specified conditions.", "tags": [], "territory": "Federal", "title": "The Secretary has statutory authority to terminate a Medicare Advantage organization contract under specified conditions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The Secretary may contract with eligible entities as Medicare administrative contractors for specified payment, provider-service, and beneficiary-service functions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395kk-1(a)(1) to (4) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:85eb3cf80c7485f9b4f09093", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Acquire current contract jurisdictions, awards, functions, and subcontractors.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "The Secretary may contract with eligible entities as Medicare administrative contractors for specified payment, provider-service, and beneficiary-service functions.", "tags": [], "territory": "Federal", "title": "The Secretary may contract with eligible entities as Medicare administrative contractors for specified payment, provider-service, and beneficiary-service functions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The Secretary must enter qualifying agreements to use willing state or local agencies for specified Medicare provider survey and certification functions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395aa(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:84d3ecf4c85731d077a8409b", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Review provider-type scope, accreditation alternatives, and current agreements.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "The Secretary must enter qualifying agreements to use willing state or local agencies for specified Medicare provider survey and certification functions.", "tags": [], "territory": "Federal", "title": "The Secretary must enter qualifying agreements to use willing state or local agencies for specified Medicare provider survey and certification functions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The acquired Title XVIII and XIX texts are 2024 annual Code editions and cannot alone establish the law in force on 10 August 2026.", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Both GovInfo 2024 packages and excluded 2025 not-found artifacts" }, "material_id": "material:d9cba07d25edbe2543b5a067", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Check all later public laws, current Compilation pages, regulations, and effective dates.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence." ], "origin": "candidate-claim-qa-queue", "period": "2024 edition versus 2026 snapshot", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": {}, "statement": "The acquired Title XVIII and XIX texts are 2024 annual Code editions and cannot alone establish the law in force on 10 August 2026.", "tags": [], "territory": "Federal", "title": "The acquired Title XVIII and XIX texts are 2024 annual Code editions and cannot alone establish the law in force on 10 August 2026.", "urls": [] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The dataset exposes facility name, address, hospital type, a reported hospital-ownership category, emergency-services status, and selected measures.. https://data.cms.gov/provider-data/sites/default/files/data_dictionaries/hospital/HOSPITAL_Data_Dictionary.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Same CSV header and dictionary `Hospital General Information` table | Public authoritative source: https://data.cms.gov/provider-data/sites/default/files/data_dictionaries/hospital/HOSPITAL_Data_Dictionary.pdf" }, "material_id": "material:8f8229852ca992c58ebfe42a", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Validate null codes, category definitions, temporal meaning, and change history.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence." ], "origin": "candidate-claim-qa-queue", "period": "April and May 2026 files", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": {}, "statement": "The dataset exposes facility name, address, hospital type, a reported hospital-ownership category, emergency-services status, and selected measures.", "tags": [], "territory": "Federal", "title": "The dataset exposes facility name, address, hospital type, a reported hospital-ownership category, emergency-services status, and selected measures.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://data.cms.gov/provider-data/sites/default/files/data_dictionaries/hospital/HOSPITAL_Data_Dictionary.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The federal managed-care framework generally requires a choice of at least two qualifying entities, subject to stated rural and other rules.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(a)(3) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:9d7b99796deb20e9403fcf85", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Verify current exceptions and California county model.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The federal managed-care framework generally requires a choice of at least two qualifying entities, subject to stated rural and other rules.", "tags": [], "territory": "Federal", "title": "The federal managed-care framework generally requires a choice of at least two qualifying entities, subject to stated rural and other rules.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The frozen CSV contains 5,432 rows and 5,432 unique six-character facility IDs.. https://data.cms.gov/provider-data/dataset/xubh-q36u", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": null, "institution": null, "locator": { "description": "`USA-CMS-HOSPITAL-CSV-2026-05-13`, full-file row and first-field derivation | Public authoritative source: https://data.cms.gov/provider-data/dataset/xubh-q36u" }, "material_id": "material:7179a33d3bbd5b986d52615a", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Store script, hash, exclusions, and leading-zero preservation.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Frozen 2026-05-13 distribution", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "11612c367d9de8eaa47ad3b9cda178477e7fc9e12a30113d0e52b3eb029a7ab2" }, "statement": "The frozen CSV contains 5,432 rows and 5,432 unique six-character facility IDs.", "tags": [], "territory": "Federal", "title": "The frozen CSV contains 5,432 rows and 5,432 unique six-character facility IDs.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://data.cms.gov/provider-data/dataset/xubh-q36u" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(6) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:688da47fc414ed7ccce330d8", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Acquire current reporting regulations and California submissions.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.", "tags": [], "territory": "Federal", "title": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(33)(B) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:3f60c38d7ff5cb52f171d0b4", "notes": [ "Heuristic flags are prompts for annotation and do not alter the displayed source record.", "Map the selected state's agency split and current survey agreements.", "Administrative boundaries do not establish service territories", "Do not infer territorial responsibility from administrative boundaries.", "territorial evidence identifying the service geography type, responsible actors, providers or networks, period, and geospatial or textual basis.", "Common ownership does not establish service integration", "Do not infer integration from common ownership.", "evidence of shared governance, pathways, records, teams, coordination, population responsibility, joint planning, or another registered integration mechanism.", "Facility count does not establish private-sector dominance", "Do not infer private dominance from facility count alone.", "sector-specific evidence with explicit denominators and a stated meaning for ownership, capacity, activity, expenditure, or service role.", "Federalism does not establish operational decentralization", "Do not infer decentralization from federalism alone.", "function-specific decision-right evidence naming the actor, role, territory, provider scope, and valid period.", "Legal authority does not establish implementation", "Do not infer implementation from legal authority.", "reported or observed evidence of implementation with compatible jurisdiction, provider scope, territory, and period.", "Ownership does not establish provider autonomy", "Do not infer provider autonomy from ownership alone.", "decision-domain evidence identifying the provider's authority, constraints, autonomous-from actor, accountability mechanism, and period.", "Primary care presence does not establish gatekeeping", "Do not infer gatekeeping from primary care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "candidate-claim-qa-queue", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "claim_quality_review_record", "record_kind_label": "Claim Quality Review Record", "screening": { "previous_boundary_detected": true, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "needs_review" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.", "tags": [], "territory": "Federal", "title": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 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care presence.", "evidence of registration, first-contact rules, referral requirements, bypass conditions, patient choice, and applicable scope.", "Provider count does not establish competition", "Do not infer competition from provider count.", "competition evidence with a defined market, dimension, denominator, territory, period, and limitations.", "Referral policy does not establish observed compliance", "Do not infer referral compliance from referral policy.", "observed evidence of referrals, bypass, leakage, patient flow, compliance, or implementation for a compatible territory and period.", "Reporting does not establish accountability", "Do not infer accountability from reporting alone.", "evidence naming the accountable organization, accountability mechanism, decision scope, period, and any enforcement or consequence.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": 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"5b9bdfb7061a75eff9c1c3ff8a7ee2b03be8c707921287959219342971848c5e" }, "statement": "The NCHS emergency-department summary tables provide survey-based 2022 visit data. They support a bounded observation about the survey's emergency-department visit domain, not an ownership census, a national outpatient network graph, individual longitudinal pathways, or referral completion.", "tags": [], "territory": "United States emergency department visits represented by the 2022 NHAMCS", "title": "2022 National Hospital Ambulatory Medical Care Survey: Emergency Department Summary Tables", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cdc.gov/nchs/data/nhamcs/web_tables/2022-nhamcs-ed-web-tables.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Office of the Federal Register. 42 CFR 482.43, Condition of participation: Discharge planning, 2024 edition. https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol5/xml/CFR-2024-title42-vol5-sec482-43.xml", "country_ids": [ "USA" ], "coverage_domains": [ "autonomy", "decision_rights", "governance", "hospital_organization", "patient_flows", "referral_design" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "The hospital must have an effective discharge planning process", "institution": "Office of the Federal Register and Government Publishing Office", "locator": { "description": "42 CFR 482.43, opening paragraph." }, "material_id": "material:5f9e1b23648c0b9d95620bef", "notes": [ "Do not turn a federal participation condition into evidence of discharge-planning quality, completed referral, or practice outside its legal scope." ], "origin": "country-evidence-improvement-sources", "period": "2024-10-01 Code of Federal Regulations edition", "publication_date": null, "publication_year": 2024, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/xml", "response_sha256": "e8d3090600e2f9edf1a1afd05d4f6f90ff01e6d8d00660bffeefce92411ef6fe" }, "statement": "The regulation requires a covered hospital to maintain an effective discharge-planning process focused on patient goals and treatment preferences, with patients and caregivers as active partners for post-discharge care. 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This agency resource does not describe payment for every hospital, Medicaid or commercial contract, hospital ownership, or service quality.", "tags": [], "territory": "United States Medicare acute inpatient prospective payment system", "title": "Acute Inpatient PPS", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Centers for Medicare & Medicaid Services. 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It says an appropriate transfer should be implemented when a hospital cannot stabilize within its capability or when a patient requests one; it does not measure transfers or establish routine outpatient referral performance.", "tags": [], "territory": "United States Medicare-participating hospitals with emergency departments; statutory and CMS description scope", "title": "Emergency Medical Treatment & Labor Act (EMTALA)", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "U.S. Census Bureau. 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The page does not classify the autonomy of primary-care practices or hospitals, or describe Medicaid, commercial, or all-professional payment arrangements.", "tags": [], "territory": "United States Medicare physician and other professional service payment context", "title": "Physician Fee Schedule", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Medicaid.gov. Program History and Prior Initiatives. 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It is suitable for a high-level federal and state programme context, but it does not supply a current, state-by-state operational map or provider-performance measure.", "tags": [], "territory": "United States; federal Medicaid programme history with state participation", "title": "Program History and Prior Initiatives", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.medicaid.gov/about-us/program-history/index.html" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Anderlini D. The United States Health Care System is Sick: From Adam Smith to Overspecialization. Cureus. 2018;10(5):e2720. https://www.ebi.ac.uk/europepmc/webservices/rest/PMC6067811/fullTextXML", "country_ids": [ "USA" ], "coverage_domains": [ "authoritative_review", "market_structure", "networks", "patient_flows", "primary_care", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "The failure of the US health care system", "institution": "Cureus; Europe PMC open-access full-text service", "locator": { "description": "Abstract and Review section." }, "material_id": "material:d9d559fdc00e82d79dbd86f4", "notes": [ "Use only as dated contextual review literature and do not turn its narrative interpretation into a current performance or causal claim." ], "origin": "country-evidence-improvement-sources", "period": "Review published 2018", "publication_date": null, "publication_year": 2018, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/xml", "response_sha256": "85bfa70187b23a4bd5c54397d76aa2bd016e6e8f33640fc48897f25253a854a0" }, "statement": "This 2018 narrative review discusses fragmentation, the family-doctor role and specialization in United States health care. It is contextual review literature, not a current nationally representative measure, a legal authority, or evidence that a particular current delivery model operates nationwide.", "tags": [], "territory": "United States; narrative review discussion", "title": "The United States Health Care System is Sick: From Adam Smith to Overspecialization", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.ebi.ac.uk/europepmc/webservices/rest/PMC6067811/fullTextXML" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XIX, 42 USC 1396u-2(b)(5)" }, "material_id": "display-evidence:USA:0116cf6dc8c9d57488e7", "notes": [ "An assurance is not observed proof of network adequacy.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.", "tags": [], "territory": "Federal", "title": "A Medicaid managed-care organization must give the state and Secretary assurances about service capacity and the number, mix, and geographic distribution of providers.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS19", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XIX, 42 USC 1396a(a)(5)" }, "material_id": "display-evidence:USA:ac105770cb403e21e4aa", "notes": [ "Acquire California's current approved page, statute, organization, and delegation instruments.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.", "tags": [], "territory": "Federal", "title": "A Medicaid state plan must designate or establish a single state agency to administer or supervise its administration.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS19", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "A Medicaid state plan must operate in all political subdivisions of the state and be mandatory on them if they administer it.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "`USA-USCODE-2024-T42-XIX`, 42 USC 1396a(a)(1)" }, "material_id": "display-evidence:USA:c020f609a495630b7d4e", "notes": [ "Verify later law and the selected state's administrative structure.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "2024 annual edition", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A Medicaid state plan must operate in all political subdivisions of the state and be mandatory on them if they administer it.", "tags": [], "territory": "Federal", "title": "A Medicaid state plan must operate in all political subdivisions of the state and be mandatory on them if they administer it.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS19", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "A Medicare Advantage plan cannot be elected or paid without a federal contract with its organization under section 1395w-27.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "legal_authority", "provider_contracting", "provider_organization" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XVIII, 42 USC 1395w-27(a)" }, "material_id": "display-evidence:USA:d464ab55dd0e02c89793", "notes": [ "Acquire the current contract, plan benefit package, service area, network, and effective period.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "A Medicare Advantage plan cannot be elected or paid without a federal contract with its organization under section 1395w-27.", "tags": [], "territory": "Federal", "title": "A Medicare Advantage plan cannot be elected or paid without a federal contract with its organization under section 1395w-27.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS18", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "A Medicare Advantage plan is linked to a geographic service area and enrollment generally depends on residence in that area.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "legal_authority", "provider_contracting", "provider_organization" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XVIII, 42 USC 1395w-21(b)(1)" }, "material_id": "display-evidence:USA:12d70058a255ac450271", "notes": [ "Acquire current plan service-area data and exceptions.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "A Medicare Advantage plan is linked to a geographic service area and enrollment generally depends on residence in that area.", "tags": [], "territory": "Federal", "title": "A Medicare Advantage plan is linked to a geographic service area and enrollment generally depends on residence in that area.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS18", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XIX, 42 USC 1396u-2(c)(1)" }, "material_id": "display-evidence:USA:20f5de358a3c91b04887", "notes": [ "Acquire current 42 CFR Part 438 rules, California strategy, external review, and findings.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.", "tags": [], "territory": "Federal", "title": "A state contracting with Medicaid managed-care organizations must implement a quality assessment and improvement strategy, while the Secretary sets standards and monitors implementation.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS19", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "A state health or other appropriate medical agency has specified responsibility for health standards for institutions where Medicaid recipients may receive care.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XIX, 42 USC 1396a(a)(9)" }, "material_id": "display-evidence:USA:9d13a97bafb42854e358", "notes": [ "Separate Medicaid participation standards from state facility licensing.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { 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"authors": [], "availability": { "direct_text_checkable": false }, "citation": "A state may require eligible people to enroll with a managed-care entity when the entity, state contract, and statutory safeguards meet the applicable requirements.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XIX, 42 USC 1396u-2(a)(1)" }, "material_id": "display-evidence:USA:da7cc25d5559282cea59", "notes": [ "Verify population, state authority, waiver, contract, service area, and effective period.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "A state may require eligible people to enroll with a managed-care entity when the entity, state contract, and statutory safeguards meet the applicable requirements.", "tags": [], "territory": "Federal", "title": "A state may require eligible people to enroll with a managed-care entity when the entity, state contract, and statutory safeguards meet the applicable requirements.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS19", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "An eligible person may elect original Medicare or an available Medicare Advantage plan under the statutory conditions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "legal_authority", "provider_contracting", "provider_organization" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XVIII, 42 USC 1395w-21(a)" }, "material_id": "display-evidence:USA:4ad059ca94f7948127a4", "notes": [ "Verify current terminology, eligibility, plan availability, and regulations.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "An eligible person may elect original Medicare or an available Medicare Advantage plan under the statutory conditions.", "tags": [], "territory": "Federal", "title": "An eligible person may elect original Medicare or an available Medicare Advantage plan under the statutory conditions.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS18", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "CMS metadata describes Hospital General Information as a list of hospitals registered with Medicare and reports a 13 May 2026 release.. https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/xubh-q36u", "country_ids": [ "USA" ], "coverage_domains": [ "hospital_organization" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "`USA-CMS-HOSPITAL-METADATA`, dataset `xubh-q36u`" }, "material_id": 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Medicare and reports a 13 May 2026 release.", "tags": [], "territory": "Federal", "title": "CMS metadata describes Hospital General Information as a list of hospitals registered with Medicare and reports a 13 May 2026 release.", "urls": [ { "kind": "source_reference", "source": "USA-CMS-HOSPITAL-DATASET-METADATA", "url": "https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/xubh-q36u" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "Except where Title XVIII provides otherwise, the HHS Secretary administers Medicare and may perform functions directly or by contract.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "legal_authority", "provider_contracting", "provider_organization" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, 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"statement": "Except where Title XVIII provides otherwise, the HHS Secretary administers Medicare and may perform functions directly or by contract.", "tags": [], "territory": "Federal", "title": "Except where Title XVIII provides otherwise, the HHS Secretary administers Medicare and may perform functions directly or by contract.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS18", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "Federal Medicaid payments are made to states with approved plans according to statutory matching and administrative formulas.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", 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"annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XIX, 42 USC 1396a(a)(23)" }, "material_id": "display-evidence:USA:f90152e5ca811ebfd275", "notes": [ "Never label a population free-choice or managed-care without its state authority and enrollment category.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial exceptions.", "tags": [], "territory": "Federal", "title": "Medicaid provider choice is a state-plan requirement subject to express managed-care, waiver, program, provider, and territorial 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"territory": "Federal", "title": "Medicare provider participation and payment eligibility depend on filing an agreement with the Secretary containing statutory commitments.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS18", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", 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"response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.", "tags": [], "territory": "Federal", "title": "State payment and utilization methods must address efficiency, economy, quality, and sufficient provider participation for geographic access under the statutory standard.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS19", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "The 2024 edition carries an amendment note making specified public network-provider directory duties effective on 1 July 2025.. 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}, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "The Secretary has statutory authority to terminate a Medicare Advantage organization contract under specified conditions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "legal_authority", "provider_contracting", "provider_organization" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XVIII, 42 USC 1395w-27(c)(2)" }, "material_id": "display-evidence:USA:90e17b7b193fd19023fc", "notes": [ "Review notice, appeal, regulation, and current enforcement records.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": 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"displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "text/html", "response_sha256": "11612c367d9de8eaa47ad3b9cda178477e7fc9e12a30113d0e52b3eb029a7ab2" }, "statement": "The frozen CSV contains 5,432 rows and 5,432 unique six-character facility IDs.", "tags": [], "territory": "Federal", "title": "The frozen CSV contains 5,432 rows and 5,432 unique six-character facility IDs.", "urls": [ { "kind": "source_reference", "source": "CMS Hospital General Information", "url": "https://data.cms.gov/provider-data/dataset/xubh-q36u" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XIX, 42 USC 1396a(a)(6)" }, "material_id": "display-evidence:USA:2094518dd631a471d027", "notes": [ "Acquire current reporting regulations and California submissions.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.", "tags": [], "territory": "Federal", "title": "The state agency must make reports required by the Secretary and comply with provisions needed to verify them.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS19", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XIX, 42 USC 1396a(a)(33)(B)" }, "material_id": "display-evidence:USA:aa61c4a9eb9d046cf788", "notes": [ "Map the selected state's agency split and current survey agreements.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.", "tags": [], "territory": "Federal", "title": "The state or designated licensing or survey agency determines institutional participation under the state plan, subject to the Secretary's validation and binding determination authority.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS19", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": false }, "citation": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "care_networks", "legal_authority", "payment_relationship", "provider_organization", "quality_regulation" ], "display_status": "shown_in_full", "document_type": "candidate_fact", "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "USA-USCODE-2024-T42-XIX, 42 USC 1396a(a)(22)" }, "material_id": "display-evidence:USA:d6c79bb2ceaf5fb99153", "notes": [ "Acquire the selected state's approved state-plan pages and amendments.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-fact-projection", "period": "Same", "publication_date": null, "publication_year": null, "record_kind": "displayed_source_linked_statement", "record_kind_label": "Displayed source-linked statement", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "country_source_locator" ], "source_system": "country_source_locator", "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.", "tags": [], "territory": "Federal", "title": "The state plan must describe plan personnel, institutional standards, interagency cooperation, and quality-assurance methods.", "urls": [ { "kind": "source_reference", "source": "USA-GOVINFO-USCODE-2024-T42-SS19", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": {}, "citation": "Harris A, Philbin S, Post B, Jordan N, Beestrum M, Epstein R et al. Cost, Quality, and Utilization After Hospital-Physician and Hospital-Post Acute Care Vertical Integration: A Systematic Review. Medical care research and review : MCRR. 2025. doi:10.1177/10775587241247682.", "country_ids": [ "USA" ], "coverage_domains": [ "authoritative_review", "hospital_organization", "market_structure", "networks", "ownership" ], "display_status": "shown_in_full", "document_type": "candidate source metadata", "evidence_mode": null, "excerpt": null, "institution": null, "locator": null, "material_id": "candidate-source:USA:60ba2e9888f1d0c1352e", "notes": [ "Public source projection retained as a distinct stage record.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-source-projection", "period": null, "publication_date": null, "publication_year": 2025, "record_kind": "displayed_source_projection", "record_kind_label": "Displayed source projection", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "candidate_source_metadata", "review_literature" ], "source_system": "pubmed_country_review_seed", "source_version": { "detected_media_type": "text/xml", "response_sha256": "cebcf15e36788c139ea43dd4a4c2135a7d0c2c8c423f43accca428aed64f42b8" }, "statement": null, "tags": [ "curated_review" ], "territory": null, "title": "Cost, Quality, and Utilization After Hospital-Physician and Hospital-Post Acute Care Vertical Integration: A Systematic Review", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pubmed.ncbi.nlm.nih.gov/38708895/" } ] }, { "annotation_status": "open", "authors": [], "availability": {}, "citation": "Reforming health social security : proceedings of an international seminar sponsored by the Global Security Institute, Keio University, and the World Bank, June 27-29, 2005, Tokyo, Japan : Reforming health social security : proceedings of an international seminar. 2005. https://documents1.worldbank.org/curated/en/253691468215691871/pdf/363940REV0Keio0Paper0for0WB0Web.pdf", "country_ids": [ "USA" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": "candidate corpus source", "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "physical_pdf_page": 7, "source_word_anchor": "the form of specific contract provisions for providers In contrast in Canada" }, "material_id": "candidate-source:USA:5f99458df3635fed8414", "notes": [ "Public source projection retained as a distinct stage record." ], "origin": "current-public-source-projection", "period": null, "publication_date": null, "publication_year": 2005, "record_kind": "displayed_source_projection", "record_kind_label": "Displayed source projection", "screening": { "previous_visibility": "previously_projected" }, "source_layers": [ "candidate_corpus_page_locator", "grey_literature" ], "source_system": "global_corpus", "source_version": { "file_sha256": "76b9063b46ff55b0f06104d324f3e83b532ac12eb5a32a3853815d9ff659866e", "text_sha256": "e0a37c34520ff10e918d1487647e0db69bc746f5f2f514135f8957ddacd4633d" }, "statement": null, "tags": [ "corpus_excerpt_queue" ], "territory": null, "title": "Reforming health social security : proceedings of an international seminar sponsored by the Global Security Institute, Keio University, and the World Bank, June 27-29, 2005, Tokyo, Japan : Reforming health social security : proceedings of an international seminar", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://documents1.worldbank.org/curated/en/253691468215691871/pdf/363940REV0Keio0Paper0for0WB0Web.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": {}, "citation": "Nyweide DJ. The First Decade of ACO Model Evaluations in the Medicare Program: A Systematic Review. Medical care research and review : MCRR. 2026. doi:10.1177/10775587251325914.", "country_ids": [ "USA" ], "coverage_domains": [ "authoritative_review", "hospital_organization", "networks", "reform_history" ], "display_status": "shown_in_full", "document_type": "candidate source metadata", "evidence_mode": null, "excerpt": null, "institution": null, "locator": null, "material_id": "candidate-source:USA:f3439bc36e3db605529e", "notes": [ "Public source projection retained as a distinct stage record.", "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "current-public-source-projection", "period": null, "publication_date": null, "publication_year": 2026, "record_kind": "displayed_source_projection", "record_kind_label": "Displayed source projection", "screening": { "previous_visibility": "previously_projected", "source_version_linked_from_country_score_acquisition": true }, "source_layers": [ "candidate_source_metadata", "review_literature" ], "source_system": "pubmed_country_review_seed", "source_version": { "detected_media_type": "text/xml", "response_sha256": "cf07f21d89e27823881e6eca72f68609f014718545baecb52313d80821182548" }, "statement": null, "tags": [ "curated_review" ], "territory": null, "title": "The First Decade of ACO Model Evaluations in the Medicare Program: A Systematic Review", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pubmed.ncbi.nlm.nih.gov/40338021/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Acquire California's current approved page, statute, organization, and delegation instruments.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "claim_review" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(5) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:ebb4c4c12c87a438c1a63a83", "notes": [ "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "discovery-tasks", "period": null, "publication_date": null, "publication_year": null, "record_kind": "evidence_gap_record", "record_kind_label": "Evidence Gap Record", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "queued" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "Acquire California's current approved page, statute, organization, and delegation instruments.", "tags": [], "territory": "Federal", "title": "Acquire California's current approved page, statute, organization, and delegation instruments.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Acquire current 42 CFR Part 438 rules, California strategy, external review, and findings.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "claim_review" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396u-2(c)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:713650fa3c57ad7162aaaceb", "notes": [ "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "discovery-tasks", "period": null, "publication_date": null, "publication_year": null, "record_kind": "evidence_gap_record", "record_kind_label": "Evidence Gap Record", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "queued" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "Acquire current 42 CFR Part 438 rules, California strategy, external review, and findings.", "tags": [], "territory": "Federal", "title": "Acquire current 42 CFR Part 438 rules, California strategy, external review, and findings.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Acquire current contract jurisdictions, awards, functions, and subcontractors.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "claim_review" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395kk-1(a)(1) to (4) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:cf7abe2b65b4932ecd813995", "notes": [ "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "discovery-tasks", "period": null, "publication_date": null, "publication_year": null, "record_kind": "evidence_gap_record", "record_kind_label": "Evidence Gap Record", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "queued" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "Acquire current contract jurisdictions, awards, functions, and subcontractors.", "tags": [], "territory": "Federal", "title": "Acquire current contract jurisdictions, awards, functions, and subcontractors.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Acquire current federal matching rates, state expenditures, and reconciliation records.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "claim_review" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396b(a) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:51d7e02e49bfb926cc4e9754", "notes": [ "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "discovery-tasks", "period": null, "publication_date": null, "publication_year": null, "record_kind": "evidence_gap_record", "record_kind_label": "Evidence Gap Record", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "queued" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "Acquire current federal matching rates, state expenditures, and reconciliation records.", "tags": [], "territory": "Federal", "title": "Acquire current federal matching rates, state expenditures, and reconciliation records.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Acquire current plan service-area data and exceptions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "claim_review" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1395w-21(b)(1) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" }, "material_id": "material:1e19fbdc8471f1a5adc4818e", "notes": [ "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "discovery-tasks", "period": null, "publication_date": null, "publication_year": null, "record_kind": "evidence_gap_record", "record_kind_label": "Evidence Gap Record", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "queued" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 1119, "response_sha256": "46e30dc26aa99ac2357a6bb0c9a4ba6fb5e986a0b5a479277bae141c88b1ed45" }, "statement": "Acquire current plan service-area data and exceptions.", "tags": [], "territory": "Federal", "title": "Acquire current plan service-area data and exceptions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXVIII.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Acquire current reporting regulations and California submissions.. https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf", "country_ids": [ "USA" ], "coverage_domains": [ "claim_review" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "description": "Same source, 42 USC 1396a(a)(6) | Public authoritative source: https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" }, "material_id": "material:4e655e442e9399bc916479b8", "notes": [ "Immutable source-version metadata was retrieved from this exact public source URL in the single-country score-improvement acquisition." ], "origin": "discovery-tasks", "period": null, "publication_date": null, "publication_year": null, "record_kind": "evidence_gap_record", "record_kind_label": "Evidence Gap Record", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected", "source_version_linked_from_country_score_acquisition": true, "status": "queued" }, "source_layers": [], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "page_count": 414, "response_sha256": "c1b77993734e5cea3ac50ea22b469e7d24475e7b2b805bb872d259fa8f0c3ef4" }, "statement": "Acquire current reporting regulations and California submissions.", "tags": [], "territory": "Federal", "title": "Acquire current reporting regulations and California submissions.", "urls": [ { "kind": "embedded_source_url", "source": "URL supplied in source_locator_raw", "url": "https://www.govinfo.gov/content/pkg/USCODE-2024-title42/pdf/USCODE-2024-title42-chap7-subchapXIX.pdf" } ] }, { "analytical_mapping": {}, 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