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Code of Federal Regulations (Last Updated: May 6, 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 423 - Voluntary Medicare Prescription Drug Benefit |
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Subpart M - Grievances, Coverage Determinations, Redeterminations, and Reconsiderations |
| § 423.558 - Scope. |
| § 423.560 - Definitions. |
| § 423.562 - General provisions. |
| § 423.564 - Grievance procedures. |
| § 423.566 - Coverage determinations. |
| § 423.568 - Standard timeframe and notice requirements for coverage determinations. |
| § 423.570 - Expediting certain coverage determinations. |
| § 423.572 - Timeframes and notice requirements for expedited coverage determinations. |
| § 423.576 - Effect of a coverage determination. |
| § 423.578 - Exceptions process. |
| § 423.580 - Right to a redetermination. |
| § 423.582 - Request for a standard redetermination. |
| § 423.584 - Expediting certain redeterminations. |
| § 423.586 - Opportunity to submit evidence. |
| § 423.590 - Timeframes and responsibility for making redeterminations. |
| § 423.600 - Reconsideration by an independent review entity (IRE). |
| § 423.602 - Notice of reconsideration determination by the independent review entity. |
| § 423.604 - Effect of a reconsideration determination. |
| § 423.610 - Right to an ALJ hearing. |
| § 423.612 - Request for an ALJ hearing. |
| § 423.620 - Medicare Appeals Council (MAC) review. |
| § 423.630 - Judicial review. |
| §§ 423.610--423.634 - [Reserved] |
| § 423.634 - Reopening and revising determinations and decisions. |
| § 423.636 - How a Part D plan sponsor must effectuate standard redeterminations, reconsiderations, or decisions. |
| § 423.638 - How a Part D plan sponsor must effectuate expedited redeterminations or reconsiderations. |