Whenever you’re thinking about a Medicare or Medicaid related question, you often need to look to at a number of sources to thoroughly answer the question. You may not need to look at all of these sources, but generally you will need to cross reference at least a couple of them. First, there are the ones you’re probably already familiar with in any form of legal research:
Then, there are some that you may not know about, but matter a lot in practical terms:
If you are researching Medicaid, rather than Medicare, there is also the extra layer of whatever going on in the state you’re concerned with; so, you need to think about:
To give some insight into how complicated this research can be, note that even for some Medicare issues, state law does come into play. While the full complexity of this is outside the scope of this guide, a couple of examples are included here:
As part of the Medicare Conditions of Participation, certain entities receiving Medicare funds must comply with state laws, including:
CMS defers to state health care professional licensing laws in some cases to help determine who can perform and be paid for certain tasks. (42 C.F.R. § 489.20(d), see also e.g., SSA § 1861(s)(2)(K), (gg), (hh), (ii), (ll).)
In California, most statutes relating to the health care professions are in the Business and Professions Code, and most regulations are in Title 16 of the CCR. Additional information about licensure is available at the licensing boards of the various health care professions. For example:
For other licensing boards, see the ALA's Healthcare practitioners databases in State Agency Database