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Code of Federal Regulations (Last Updated: November 8, 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 C - Medical Assistance Programs |
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Part 438 - Managed Care |
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Subpart F - Grievance and Appeal System |
| § 438.400 - Statutory basis, definitions, and applicability. |
| § 438.402 - General requirements. |
| § 438.404 - Timely and adequate notice of adverse benefit determination. |
| § 438.406 - Handling of grievances and appeals. |
| § 438.408 - Resolution and notification: Grievances and appeals. |
| § 438.410 - Expedited resolution of appeals. |
| § 438.414 - Information about the grievance and appeal system to providers and subcontractors. |
| § 438.416 - Recordkeeping requirements. |
| § 438.420 - Continuation of benefits while the MCO, PIHP, or PAHP appeal and the State fair hearing are pending. |
| § 438.424 - Effectuation of reversed appeal resolutions. |
| § 438.426 - Monitoring of the grievance system. |