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Code of Federal Regulations (Last Updated: July 5, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter B - Medicare Program |
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Part 422 - Medicare Advantage Program |
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Subpart M - Grievances, Organization Determinations and Appeals |
| § 422.560 - Basis and scope. |
| § 422.561 - Definitions. |
| § 422.562 - General provisions. |
| § 422.564 - Grievance procedures. |
| § 422.566 - Organization determinations. |
| § 422.568 - Standard timeframes and notice requirements for organization determinations. |
| § 422.570 - Expediting certain organization determinations. |
| § 422.572 - Timeframes and notice requirements for expedited organization determinations. |
| § 422.574 - Parties to the organization determination. |
| § 422.576 - Effect of an organization determination. |
| § 422.578 - Right to a reconsideration. |
| § 422.580 - Reconsideration defined. |
| § 422.582 - Request for a standard reconsideration. |
| § 422.584 - Expediting certain reconsiderations. |
| § 422.586 - Opportunity to submit evidence. |
| § 422.590 - Timeframes and responsibility for reconsiderations. |
| § 422.592 - Reconsideration by an independent entity. |
| § 422.594 - Notice of reconsidered determination by the independent entity. |
| § 422.596 - Effect of a reconsidered determination. |
| § 422.600 - Right to a hearing. |
| § 422.602 - Request for an ALJ hearing. |
| § 422.608 - Medicare Appeals Council (Council) review. |
| § 422.612 - Judicial review. |
| § 422.616 - Reopening and revising determinations and decisions. |
| § 422.618 - How an MA organization must effectuate standard reconsidered determinations or decisions. |
| § 422.619 - How an MA organization must effectuate expedited reconsidered determinations. |
| § 422.620 - Notifying enrollees of hospital discharge appeal rights. |
| § 422.622 - Requesting immediate QIO review of the decision to discharge from the inpatient hospital. |
| § 422.624 - Notifying enrollees of termination of provider services. |
| § 422.626 - Fast-track appeals of service terminations to independent review entities (IREs). |
| § 422.630 - xxx |
| § 422.632 - xxx |
| § 422.634 - xxx |
| Requirements Applicable to Certain Integrated Dual Eligible Special Needs Plans |
| § 422.629 - General requirements for applicable integrated plans. |
| § 422.631 - Integrated organization determinations. |
| § 422.633 - Integrated reconsiderations. |