GenIC #1 - Initial Application

Template A3– Assurances

Statute:

Regulation:

INTRODUCTION

In template A3, the State provides assurances as to various administrative functions, performed by the State Medicaid agency, and compliance with certain regulatory requirements.

BACKGROUND

States may indicate that they comply with certain statutory or regulatory provisions by providing assurances to that effect in their State plans. Assurances required in this section include:

• That the State Plan is in operation on a statewide basis, in accordance with all the requirements of 42 CFR 435.510;

• That all provisions of this plan are administered by the Medicaid agency except for those functions for which final authority has been granted to a Professional Standards Review Organization under title XI of the Act;

• That all requirements of 42 CFR 431.10 are met;

• That there is a Medical Care Advisory Committee to the agency director on health and medical services established in accordance with meeting all the requirements of 42 CFR §431.12; and

• That there is a written agreement between the Medicaid agency and the Federal or other State or local agencies that determine eligibility for Medicaid in compliance with 42 CFR 431.10(d)

• That State or local agencies or offices that perform services for the Medicaid agency must not have the authority to change or disapprove any administrative decision of that agency, or otherwise substitute their judgment for that of the Medicaid agency with respect to the application of policies, rules, and regulations issued by the Medicaid agency.

TECHNICAL GUIDANCE

In template A3 the State is being asked to provide the assurances listed above.

The State provides these affirmative assurances by checking the boxes next to the assurance statements. If the State does not check this box, the system will not accept this template for review and approval.