Title 42

PART 422

Part 422 - Medicare Advantage Program

PART 422 - MEDICARE ADVANTAGE PROGRAM Authority:42 U.S.C. 1302 and 1395hh. Source:63 FR 18134, Apr. 14, 1998, unless otherwise noted. Editorial Note:Nomenclature changes to part 422 appear at 70 FR 4741, Jan. 28, 2005.

• Authority: 42 U.S.C. 1302 and 1395hh.
• Source: 63 FR 18134, Apr. 14, 1998, unless otherwise noted.

42:3.0.1.1.9.1	SUBPART A	Subpart A - General Provisions
42:3.0.1.1.9.1.10.1	SECTION 422.1	422.1 Basis and scope.
42:3.0.1.1.9.1.10.2	SECTION 422.2	422.2 Definitions.
42:3.0.1.1.9.1.10.3	SECTION 422.3	422.3 MA organizations' use of reinsurance.
42:3.0.1.1.9.1.10.4	SECTION 422.4	422.4 Types of MA plans.
42:3.0.1.1.9.1.10.5	SECTION 422.6	422.6 Cost-sharing in enrollment-related costs.
42:3.0.1.1.9.2	SUBPART B	Subpart B - Eligibility, Election, and Enrollment
42:3.0.1.1.9.2.10.1	SECTION 422.50	422.50 Eligibility to elect an MA plan.
42:3.0.1.1.9.2.10.2	SECTION 422.52	422.52 Eligibility to elect an MA plan for special needs individuals.
42:3.0.1.1.9.2.10.3	SECTION 422.53	422.53 Eligibility to elect an MA plan for senior housing facility residents.
42:3.0.1.1.9.2.10.4	SECTION 422.54	422.54 Continuation of enrollment for MA local plans.
42:3.0.1.1.9.2.10.5	SECTION 422.56	422.56 Enrollment in an MA MSA plan.
42:3.0.1.1.9.2.10.6	SECTION 422.57	422.57 Limited enrollment under MA RFB plans.
42:3.0.1.1.9.2.10.7	SECTION 422.60	422.60 Election process.
42:3.0.1.1.9.2.10.8	SECTION 422.62	422.62 Election of coverage under an MA plan.
42:3.0.1.1.9.2.10.9	SECTION 422.64	422.64 Information about the MA program.
42:3.0.1.1.9.2.10.10	SECTION 422.66	422.66 Coordination of enrollment and disenrollment through MA organizations.
42:3.0.1.1.9.2.10.11	SECTION 422.68	422.68 Effective dates of coverage and change of coverage.
42:3.0.1.1.9.2.10.12	SECTION 422.74	422.74 Disenrollment by the MA organization.
42:3.0.1.1.9.3	SUBPART C	Subpart C - Benefits and Beneficiary Protections
42:3.0.1.1.9.3.10.1	SECTION 422.100	422.100 General requirements.
42:3.0.1.1.9.3.10.2	SECTION 422.101	422.101 Requirements relating to basic benefits.
42:3.0.1.1.9.3.10.3	SECTION 422.102	422.102 Supplemental benefits.
42:3.0.1.1.9.3.10.4	SECTION 422.103	422.103 Benefits under an MA MSA plan.
42:3.0.1.1.9.3.10.5	SECTION 422.104	422.104 Special rules on supplemental benefits for MA MSA plans.
42:3.0.1.1.9.3.10.6	SECTION 422.105	422.105 Special rules for self-referral and point of service option.
42:3.0.1.1.9.3.10.7	SECTION 422.106	422.106 Coordination of benefits with employer or union group health plans and Medicaid.
42:3.0.1.1.9.3.10.8	SECTION 422.107	422.107 Special needs plans and dual eligibles: Contract with State Medicaid Agency.
42:3.0.1.1.9.3.10.9	SECTION 422.108	422.108 Medicare secondary payer (MSP) procedures.
42:3.0.1.1.9.3.10.10	SECTION 422.109	422.109 Effect of national coverage determinations (NCDs) and legislative changes in benefits.
42:3.0.1.1.9.3.10.11	SECTION 422.110	422.110 Discrimination against beneficiaries prohibited.
42:3.0.1.1.9.3.10.12	SECTION 422.111	422.111 Disclosure requirements.
42:3.0.1.1.9.3.10.13	SECTION 422.112	422.112 Access to services.
42:3.0.1.1.9.3.10.14	SECTION 422.113	422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance and post-stabilization care services.
42:3.0.1.1.9.3.10.15	SECTION 422.114	422.114 Access to services under an MA private fee-for-service plan.
42:3.0.1.1.9.3.10.16	SECTION 422.116	422.116 Network adequacy.
42:3.0.1.1.9.3.10.17	SECTION 422.118	422.118 Confidentiality and accuracy of enrollee records.
42:3.0.1.1.9.3.10.18	SECTION 422.119	422.119 Access to and exchange of health data and plan information.
42:3.0.1.1.9.3.10.19	SECTION 422.120	422.120 Access to published provider directory information.
42:3.0.1.1.9.3.10.20	SECTION 422.128	422.128 Information on advance directives.
42:3.0.1.1.9.3.10.21	SECTION 422.132	422.132 Protection against liability and loss of benefits.
42:3.0.1.1.9.3.10.22	SECTION 422.133	422.133 Return to home skilled nursing facility.
42:3.0.1.1.9.3.10.23	SECTION 422.134	422.134 Reward and incentive programs.
42:3.0.1.1.9.3.10.24	SECTION 422.135	422.135 Additional telehealth benefits.
42:3.0.1.1.9.3.10.25	SECTION 422.136	422.136 Medicare Advantage (MA) and step therapy for Part B drugs.
42:3.0.1.1.9.4	SUBPART D	Subpart D - Quality Improvement
42:3.0.1.1.9.4.10.1	SECTION 422.152	422.152 Quality improvement program.
42:3.0.1.1.9.4.10.2	SECTION 422.153	422.153 Use of quality improvement organization review information.
42:3.0.1.1.9.4.10.3	SECTION 422.156	422.156 Compliance deemed on the basis of accreditation.
42:3.0.1.1.9.4.10.4	SECTION 422.157	422.157 Accreditation organizations.
42:3.0.1.1.9.4.10.5	SECTION 422.158	422.158 Procedures for approval of accreditation as a basis for deeming compliance.
42:3.0.1.1.9.4.10.6	SECTION 422.160	422.160 Basis and scope of the Medicare Advantage Quality Rating System.
42:3.0.1.1.9.4.10.7	SECTION 422.162	422.162 Medicare Advantage Quality Rating System.
42:3.0.1.1.9.4.10.8	SECTION 422.164	422.164 Adding, updating, and removing measures.
42:3.0.1.1.9.4.10.9	SECTION 422.166	422.166 Calculation of Star Ratings.
42:3.0.1.1.9.5	SUBPART E	Subpart E - Relationships With Providers
42:3.0.1.1.9.5.10.1	SECTION 422.200	422.200 Basis and scope.
42:3.0.1.1.9.5.10.2	SECTION 422.202	422.202 Participation procedures.
42:3.0.1.1.9.5.10.3	SECTION 422.204	422.204 Provider selection and credentialing.
42:3.0.1.1.9.5.10.4	SECTION 422.205	422.205 Provider antidiscrimination rules.
42:3.0.1.1.9.5.10.5	SECTION 422.206	422.206 Interference with health care professionals' advice to enrollees prohibited.
42:3.0.1.1.9.5.10.6	SECTION 422.208	422.208 Physician incentive plans: requirements and limitations.
42:3.0.1.1.9.5.10.7	SECTION 422.210	422.210 Assurances to CMS.
42:3.0.1.1.9.5.10.8	SECTION 422.212	422.212 Limitations on provider indemnification.
42:3.0.1.1.9.5.10.9	SECTION 422.214	422.214 Special rules for services furnished by noncontract providers.
42:3.0.1.1.9.5.10.10	SECTION 422.216	422.216 Special rules for MA private fee-for-service plans.
42:3.0.1.1.9.5.10.11	SECTION 422.220	422.220 Exclusion of services furnished under a private contract.
42:3.0.1.1.9.5.10.12	SECTION 422.222	422.222 Preclusion list for contracted and non-contracted individuals and entities.
42:3.0.1.1.9.5.10.13	SECTION 422.224	422.224 Payment to individuals and entities excluded by the OIG or included on the preclusion list.
42:3.0.1.1.9.6	SUBPART F	Subpart F - Submission of Bids, Premiums, and Related Information and Plan Approval
42:3.0.1.1.9.6.10.1	SECTION 422.250	422.250 Basis and scope.
42:3.0.1.1.9.6.10.2	SECTION 422.252	422.252 Terminology.
42:3.0.1.1.9.6.10.3	SECTION 422.254	422.254 Submission of bids.
42:3.0.1.1.9.6.10.4	SECTION 422.256	422.256 Review, negotiation, and approval of bids.
42:3.0.1.1.9.6.10.5	SECTION 422.258	422.258 Calculation of benchmarks.
42:3.0.1.1.9.6.10.6	SECTION 422.260	422.260 Appeals of quality bonus payment determinations.
42:3.0.1.1.9.6.10.7	SECTION 422.262	422.262 Beneficiary premiums.
42:3.0.1.1.9.6.10.8	SECTION 422.264	422.264 Calculation of savings.
42:3.0.1.1.9.6.10.9	SECTION 422.266	422.266 Beneficiary rebates.
42:3.0.1.1.9.6.10.10	SECTION 422.270	422.270 Incorrect collections of premiums and cost-sharing.
42:3.0.1.1.9.6.10.11	SECTION 422.272	422.272 Release of MA bid pricing data.
42:3.0.1.1.9.7	SUBPART G	Subpart G - Payments to Medicare Advantage Organizations
42:3.0.1.1.9.7.10.1	SECTION 422.300	422.300 Basis and scope.
42:3.0.1.1.9.7.10.2	SECTION 422.304	422.304 Monthly payments.
42:3.0.1.1.9.7.10.3	SECTION 422.306	422.306 Annual MA capitation rates.
42:3.0.1.1.9.7.10.4	SECTION 422.308	422.308 Adjustments to capitation rates, benchmarks, bids, and payments.
42:3.0.1.1.9.7.10.5	SECTION 422.310	422.310 Risk adjustment data.
42:3.0.1.1.9.7.10.6	SECTION 422.311	422.311 RADV audit dispute and appeal processes.
42:3.0.1.1.9.7.10.7	SECTION 422.312	422.312 Announcement of annual capitation rate, benchmarks, and methodology changes.
42:3.0.1.1.9.7.10.8	SECTION 422.314	422.314 Special rules for beneficiaries enrolled in MA MSA plans.
42:3.0.1.1.9.7.10.9	SECTION 422.316	422.316 Special rules for payments to Federally qualified health centers.
42:3.0.1.1.9.7.10.10	SECTION 422.318	422.318 Special rules for coverage that begins or ends during an inpatient hospital stay.
42:3.0.1.1.9.7.10.11	SECTION 422.320	422.320 Special rules for hospice care.
42:3.0.1.1.9.7.10.12	SECTION 422.322	422.322 Source of payment and effect of MA plan election on payment.
42:3.0.1.1.9.7.10.13	SECTION 422.324	422.324 Payments to MA organizations for graduate medical education costs.
42:3.0.1.1.9.7.10.14	SECTION 422.326	422.326 Reporting and returning of overpayments.
42:3.0.1.1.9.7.10.15	SECTION 422.330	422.330 CMS-identified overpayments associated with payment data submitted by MA organizations.
42:3.0.1.1.9.8	SUBPART H	Subpart H - Provider-Sponsored Organizations
42:3.0.1.1.9.8.10.1	SECTION 422.350	422.350 Basis, scope, and definitions.
42:3.0.1.1.9.8.10.2	SECTION 422.352	422.352 Basic requirements.
42:3.0.1.1.9.8.10.3	SECTION 422.354	422.354 Requirements for affiliated providers.
42:3.0.1.1.9.8.10.4	SECTION 422.356	422.356 Determining substantial financial risk and majority financial interest.
42:3.0.1.1.9.8.10.5	SECTION 422.370	422.370 Waiver of State licensure.
42:3.0.1.1.9.8.10.6	SECTION 422.372	422.372 Basis for waiver of State licensure.
42:3.0.1.1.9.8.10.7	SECTION 422.374	422.374 Waiver request and approval process.
42:3.0.1.1.9.8.10.8	SECTION 422.376	422.376 Conditions of the waiver.
42:3.0.1.1.9.8.10.9	SECTION 422.378	422.378 Relationship to State law.
42:3.0.1.1.9.8.10.10	SECTION 422.380	422.380 Solvency standards.
42:3.0.1.1.9.8.10.11	SECTION 422.382	422.382 Minimum net worth amount.
42:3.0.1.1.9.8.10.12	SECTION 422.384	422.384 Financial plan requirement.
42:3.0.1.1.9.8.10.13	SECTION 422.386	422.386 Liquidity.
42:3.0.1.1.9.8.10.14	SECTION 422.388	422.388 Deposits.
42:3.0.1.1.9.8.10.15	SECTION 422.390	422.390 Guarantees.
42:3.0.1.1.9.9	SUBPART I	Subpart I - Organization Compliance With State Law and Preemption by Federal Law
42:3.0.1.1.9.9.10.1	SECTION 422.400	422.400 State licensure requirement.
42:3.0.1.1.9.9.10.2	SECTION 422.402	422.402 Federal preemption of State law.
42:3.0.1.1.9.9.10.3	SECTION 422.404	422.404 State premium taxes prohibited.
42:3.0.1.1.9.10	SUBPART J	Subpart J - Special Rules for MA Regional Plans
42:3.0.1.1.9.10.10.1	SECTION 422.451	422.451 Moratorium on new local preferred provider organization plans.
42:3.0.1.1.9.10.10.2	SECTION 422.455	422.455 Special rules for MA Regional Plans.
42:3.0.1.1.9.10.10.3	SECTION 422.458	422.458 Risk sharing with regional MA organizations for 2006 and 2007.
42:3.0.1.1.9.11	SUBPART K	Subpart K - Application Procedures and Contracts for Medicare Advantage Organizations
42:3.0.1.1.9.11.10.1	SECTION 422.500	422.500 Scope and definitions.
42:3.0.1.1.9.11.10.2	SECTION 422.501	422.501 Application requirements.
42:3.0.1.1.9.11.10.3	SECTION 422.502	422.502 Evaluation and determination procedures.
42:3.0.1.1.9.11.10.4	SECTION 422.503	422.503 General provisions.
42:3.0.1.1.9.11.10.5	SECTION 422.504	422.504 Contract provisions.
42:3.0.1.1.9.11.10.6	SECTION 422.505	422.505 Effective date and term of contract.
42:3.0.1.1.9.11.10.7	SECTION 422.506	422.506 Nonrenewal of contract.
42:3.0.1.1.9.11.10.8	SECTION 422.508	422.508 Modification or termination of contract by mutual consent.
42:3.0.1.1.9.11.10.9	SECTION 422.510	422.510 Termination of contract by CMS.
42:3.0.1.1.9.11.10.10	SECTION 422.512	422.512 Termination of contract by the MA organization.
42:3.0.1.1.9.11.10.11	SECTION 422.514	422.514 Enrollment requirements.
42:3.0.1.1.9.11.10.12	SECTION 422.516	422.516 Validation of Part C reporting requirements.
42:3.0.1.1.9.11.10.13	SECTION 422.520	422.520 Prompt payment by MA organization.
42:3.0.1.1.9.11.10.14	SECTION 422.521	422.521 Effective date of new significant regulatory requirements.
42:3.0.1.1.9.11.10.15	SECTION 422.524	422.524 Special rules for RFB societies.
42:3.0.1.1.9.11.10.16	SECTION 422.527	422.527 Agreements with Federally qualified health centers.
42:3.0.1.1.9.11.10.17	SECTION 422.530	422.530 xxx
42:3.0.1.1.9.12	SUBPART L	Subpart L - Effect of Change of Ownership or Leasing of Facilities During Term of Contract
42:3.0.1.1.9.12.10.1	SECTION 422.550	422.550 General provisions.
42:3.0.1.1.9.12.10.2	SECTION 422.552	422.552 Novation agreement requirements.
42:3.0.1.1.9.12.10.3	SECTION 422.553	422.553 Effect of leasing of an MA organization's facilities.
42:3.0.1.1.9.13	SUBPART M	Subpart M - Grievances, Organization Determinations and Appeals
42:3.0.1.1.9.13.10	SUBJGRP 10	Requirements Applicable to Certain Integrated Dual Eligible Special Needs Plans
42:3.0.1.1.9.13.10.1	SECTION 422.560	422.560 Basis and scope.
42:3.0.1.1.9.13.10.2	SECTION 422.561	422.561 Definitions.
42:3.0.1.1.9.13.10.3	SECTION 422.562	422.562 General provisions.
42:3.0.1.1.9.13.10.4	SECTION 422.564	422.564 Grievance procedures.
42:3.0.1.1.9.13.10.5	SECTION 422.566	422.566 Organization determinations.
42:3.0.1.1.9.13.10.6	SECTION 422.568	422.568 Standard timeframes and notice requirements for organization determinations.
42:3.0.1.1.9.13.10.7	SECTION 422.570	422.570 Expediting certain organization determinations.
42:3.0.1.1.9.13.10.8	SECTION 422.572	422.572 Timeframes and notice requirements for expedited organization determinations.
42:3.0.1.1.9.13.10.9	SECTION 422.574	422.574 Parties to the organization determination.
42:3.0.1.1.9.13.10.10	SECTION 422.576	422.576 Effect of an organization determination.
42:3.0.1.1.9.13.10.11	SECTION 422.578	422.578 Right to a reconsideration.
42:3.0.1.1.9.13.10.12	SECTION 422.580	422.580 Reconsideration defined.
42:3.0.1.1.9.13.10.13	SECTION 422.582	422.582 Request for a standard reconsideration.
42:3.0.1.1.9.13.10.14	SECTION 422.584	422.584 Expediting certain reconsiderations.
42:3.0.1.1.9.13.10.15	SECTION 422.586	422.586 Opportunity to submit evidence.
42:3.0.1.1.9.13.10.16	SECTION 422.590	422.590 Timeframes and responsibility for reconsiderations.
42:3.0.1.1.9.13.10.17	SECTION 422.592	422.592 Reconsideration by an independent entity.
42:3.0.1.1.9.13.10.18	SECTION 422.594	422.594 Notice of reconsidered determination by the independent entity.
42:3.0.1.1.9.13.10.19	SECTION 422.596	422.596 Effect of a reconsidered determination.
42:3.0.1.1.9.13.10.20	SECTION 422.600	422.600 Right to a hearing.
42:3.0.1.1.9.13.10.21	SECTION 422.602	422.602 Request for an ALJ hearing.
42:3.0.1.1.9.13.10.22	SECTION 422.608	422.608 Medicare Appeals Council (Council) review.
42:3.0.1.1.9.13.10.23	SECTION 422.612	422.612 Judicial review.
42:3.0.1.1.9.13.10.24	SECTION 422.616	422.616 Reopening and revising determinations and decisions.
42:3.0.1.1.9.13.10.25	SECTION 422.618	422.618 How an MA organization must effectuate standard reconsidered determinations or decisions.
42:3.0.1.1.9.13.10.26	SECTION 422.619	422.619 How an MA organization must effectuate expedited reconsidered determinations.
42:3.0.1.1.9.13.10.27	SECTION 422.620	422.620 Notifying enrollees of hospital discharge appeal rights.
42:3.0.1.1.9.13.10.28	SECTION 422.622	422.622 Requesting immediate QIO review of the decision to discharge from the inpatient hospital.
42:3.0.1.1.9.13.10.29	SECTION 422.624	422.624 Notifying enrollees of termination of provider services.
42:3.0.1.1.9.13.10.30	SECTION 422.626	422.626 Fast-track appeals of service terminations to independent review entities (IREs).
42:3.0.1.1.9.13.10.31	SECTION 422.629	422.629 General requirements for applicable integrated plans.
42:3.0.1.1.9.13.10.32	SECTION 422.630	422.630 Integrated grievances.
42:3.0.1.1.9.13.10.33	SECTION 422.631	422.631 Integrated organization determinations.
42:3.0.1.1.9.13.10.34	SECTION 422.632	422.632 Continuation of benefits while the applicable integrated plan reconsideration is pending.
42:3.0.1.1.9.13.10.35	SECTION 422.633	422.633 Integrated reconsideration.
42:3.0.1.1.9.13.10.36	SECTION 422.634	422.634 Effect.
42:3.0.1.1.9.14	SUBPART N	Subpart N - Medicare Contract Determinations and Appeals
42:3.0.1.1.9.14.11.1	SECTION 422.641	422.641 Contract determinations.
42:3.0.1.1.9.14.11.2	SECTION 422.644	422.644 Notice of contract determination.
42:3.0.1.1.9.14.11.3	SECTION 422.646	422.646 Effect of contract determination.
42:3.0.1.1.9.14.11.4	SECTION 422.660	422.660 Right to a hearing, burden of proof, standard of proof, and standards of review.
42:3.0.1.1.9.14.11.5	SECTION 422.662	422.662 Request for hearing.
42:3.0.1.1.9.14.11.6	SECTION 422.664	422.664 Postponement of effective date of a contract determination when a request for a hearing is filed timely.
42:3.0.1.1.9.14.11.7	SECTION 422.666	422.666 Designation of hearing officer.
42:3.0.1.1.9.14.11.8	SECTION 422.668	422.668 Disqualification of hearing officer.
42:3.0.1.1.9.14.11.9	SECTION 422.670	422.670 Time and place of hearing.
42:3.0.1.1.9.14.11.10	SECTION 422.672	422.672 Appointment of representatives.
42:3.0.1.1.9.14.11.11	SECTION 422.674	422.674 Authority of representatives.
42:3.0.1.1.9.14.11.12	SECTION 422.676	422.676 Conduct of hearing.
42:3.0.1.1.9.14.11.13	SECTION 422.678	422.678 Evidence.
42:3.0.1.1.9.14.11.14	SECTION 422.680	422.680 Witnesses.
42:3.0.1.1.9.14.11.15	SECTION 422.682	422.682 Witness lists and documents.
42:3.0.1.1.9.14.11.16	SECTION 422.684	422.684 Prehearing and summary judgment.
42:3.0.1.1.9.14.11.17	SECTION 422.686	422.686 Record of hearing.
42:3.0.1.1.9.14.11.18	SECTION 422.688	422.688 Authority of hearing officer.
42:3.0.1.1.9.14.11.19	SECTION 422.690	422.690 Notice and effect of hearing decision.
42:3.0.1.1.9.14.11.20	SECTION 422.692	422.692 Review by the Administrator.
42:3.0.1.1.9.14.11.21	SECTION 422.694	422.694 Effect of Administrator's decision.
42:3.0.1.1.9.14.11.22	SECTION 422.696	422.696 Reopening of a contract determination or decision of a hearing officer or the Administrator.
42:3.0.1.1.9.15	SUBPART O	Subpart O - Intermediate Sanctions
42:3.0.1.1.9.15.11.1	SECTION 422.750	422.750 Types of intermediate sanctions and civil money penalties.
42:3.0.1.1.9.15.11.2	SECTION 422.752	422.752 Basis for imposing intermediate sanctions and civil money penalties.
42:3.0.1.1.9.15.11.3	SECTION 422.756	422.756 Procedures for imposing intermediate sanctions and civil money penalties.
42:3.0.1.1.9.15.11.4	SECTION 422.758	422.758 Collection of civil money penalties imposed by CMS.
42:3.0.1.1.9.15.11.5	SECTION 422.760	422.760 Determinations regarding the amount of civil money penalties and assessment imposed by CMS.
42:3.0.1.1.9.15.11.6	SECTION 422.762	422.762 Settlement of penalties.
42:3.0.1.1.9.15.11.7	SECTION 422.764	422.764 Other applicable provisions.
42:3.0.1.1.9.16	SUBPART P	Subparts P-S [Reserved]
42:3.0.1.1.9.17	SUBPART T	Subpart T - Appeal procedures for Civil Money Penalties
42:3.0.1.1.9.17.11.1	SECTION 422.1000	422.1000 Basis and scope.
42:3.0.1.1.9.17.11.2	SECTION 422.1002	422.1002 Definitions.
42:3.0.1.1.9.17.11.3	SECTION 422.1004	422.1004 Scope and applicability.
42:3.0.1.1.9.17.11.4	SECTION 422.1006	422.1006 Appeal rights.
42:3.0.1.1.9.17.11.5	SECTION 422.1008	422.1008 Appointment of representatives.
42:3.0.1.1.9.17.11.6	SECTION 422.1010	422.1010 Authority of representatives.
42:3.0.1.1.9.17.11.7	SECTION 422.1012	422.1012 Fees for services of representatives.
42:3.0.1.1.9.17.11.8	SECTION 422.1014	422.1014 Charge for transcripts.
42:3.0.1.1.9.17.11.9	SECTION 422.1016	422.1016 Filing of briefs with the Administrative Law Judge or Departmental Appeals Board, and opportunity for rebuttal.
42:3.0.1.1.9.17.11.10	SECTION 422.1018	422.1018 Notice and effect of initial determinations.
42:3.0.1.1.9.17.11.11	SECTION 422.1020	422.1020 Request for hearing.
42:3.0.1.1.9.17.11.12	SECTION 422.1022	422.1022 Parties to the hearing.
42:3.0.1.1.9.17.11.13	SECTION 422.1024	422.1024 Designation of hearing official.
42:3.0.1.1.9.17.11.14	SECTION 422.1026	422.1026 Disqualification of Administrative Law Judge.
42:3.0.1.1.9.17.11.15	SECTION 422.1028	422.1028 Prehearing conference.
42:3.0.1.1.9.17.11.16	SECTION 422.1030	422.1030 Notice of prehearing conference.
42:3.0.1.1.9.17.11.17	SECTION 422.1032	422.1032 Conduct of prehearing conference.
42:3.0.1.1.9.17.11.18	SECTION 422.1034	422.1034 Record, order, and effect of prehearing conference.
42:3.0.1.1.9.17.11.19	SECTION 422.1036	422.1036 Time and place of hearing.
42:3.0.1.1.9.17.11.20	SECTION 422.1038	422.1038 Change in time and place of hearing.
42:3.0.1.1.9.17.11.21	SECTION 422.1040	422.1040 Joint hearings.
42:3.0.1.1.9.17.11.22	SECTION 422.1042	422.1042 Hearing on new issues.
42:3.0.1.1.9.17.11.23	SECTION 422.1044	422.1044 Subpoenas.
42:3.0.1.1.9.17.11.24	SECTION 422.1046	422.1046 Conduct of hearing.
42:3.0.1.1.9.17.11.25	SECTION 422.1048	422.1048 Evidence.
42:3.0.1.1.9.17.11.26	SECTION 422.1050	422.1050 Witnesses.
42:3.0.1.1.9.17.11.27	SECTION 422.1052	422.1052 Oral and written summation.
42:3.0.1.1.9.17.11.28	SECTION 422.1054	422.1054 Record of hearing.
42:3.0.1.1.9.17.11.29	SECTION 422.1056	422.1056 Waiver of right to appear and present evidence.
42:3.0.1.1.9.17.11.30	SECTION 422.1058	422.1058 Dismissal of request for hearing.
42:3.0.1.1.9.17.11.31	SECTION 422.1060	422.1060 Dismissal for abandonment.
42:3.0.1.1.9.17.11.32	SECTION 422.1062	422.1062 Dismissal for cause.
42:3.0.1.1.9.17.11.33	SECTION 422.1064	422.1064 Notice and effect of dismissal and right to request review.
42:3.0.1.1.9.17.11.34	SECTION 422.1066	422.1066 Vacating a dismissal of request for hearing.
42:3.0.1.1.9.17.11.35	SECTION 422.1068	422.1068 Administrative Law Judge's decision.
42:3.0.1.1.9.17.11.36	SECTION 422.1070	422.1070 Removal of hearing to Departmental Appeals Board.
42:3.0.1.1.9.17.11.37	SECTION 422.1072	422.1072 Remand by the Administrative Law Judge.
42:3.0.1.1.9.17.11.38	SECTION 422.1074	422.1074 Right to request Departmental Appeals Board review of Administrative Law Judge's decision or dismissal.
42:3.0.1.1.9.17.11.39	SECTION 422.1076	422.1076 Request for Departmental Appeals Board review.
42:3.0.1.1.9.17.11.40	SECTION 422.1078	422.1078 Departmental Appeals Board action on request for review.
42:3.0.1.1.9.17.11.41	SECTION 422.1080	422.1080 Procedures before the Departmental Appeals Board on review.
42:3.0.1.1.9.17.11.42	SECTION 422.1082	422.1082 Evidence admissible on review.
42:3.0.1.1.9.17.11.43	SECTION 422.1084	422.1084 Decision or remand by the Departmental Appeals Board.
42:3.0.1.1.9.17.11.44	SECTION 422.1086	422.1086 Effect of Departmental Appeals Board Decision.
42:3.0.1.1.9.17.11.45	SECTION 422.1088	422.1088 Extension of time for seeking judicial review.
42:3.0.1.1.9.17.11.46	SECTION 422.1090	422.1090 Basis, timing, and authority for reopening an Administrative Law Judge or Board decision.
42:3.0.1.1.9.17.11.47	SECTION 422.1092	422.1092 Revision of reopened decision.
42:3.0.1.1.9.17.11.48	SECTION 422.1094	422.1094 Notice and effect of revised decision.
42:3.0.1.1.9.18	SUBPART U	Subpart U [Reserved]
42:3.0.1.1.9.19	SUBPART V	Subpart V - Medicare Advantage Communication Requirements
42:3.0.1.1.9.19.11.1	SECTION 422.2260	422.2260 Definitions.
42:3.0.1.1.9.19.11.2	SECTION 422.2261	422.2261 xxx
42:3.0.1.1.9.19.11.3	SECTION 422.2262	422.2262 Review and distribution of marketing materials.
42:3.0.1.1.9.19.11.4	SECTION 422.2263	422.2263 xxx
42:3.0.1.1.9.19.11.5	SECTION 422.2264	422.2264 Guidelines for CMS review.
42:3.0.1.1.9.19.11.6	SECTION 422.2265	422.2265 xxx
42:3.0.1.1.9.19.11.7	SECTION 422.2266	422.2266 xxx
42:3.0.1.1.9.19.11.8	SECTION 422.2267	422.2267 xxx
42:3.0.1.1.9.19.11.9	SECTION 422.2268	422.2268 Standards for MA organization communications and marketing.
42:3.0.1.1.9.19.11.10	SECTION 422.2272	422.2272 Licensing of marketing representatives and confirmation of marketing resources.
42:3.0.1.1.9.19.11.11	SECTION 422.2274	422.2274 Broker and agent requirements.
42:3.0.1.1.9.19.11.12	SECTION 422.2276	422.2276 Employer group retiree marketing.
42:3.0.1.1.9.20	SUBPART W	Subpart W [Reserved]
42:3.0.1.1.9.21	SUBPART X	Subpart X - Requirements for a Minimum Medical Loss Ratio
42:3.0.1.1.9.21.11.1	SECTION 422.2400	422.2400 Basis and scope.
42:3.0.1.1.9.21.11.2	SECTION 422.2401	422.2401 Definitions.
42:3.0.1.1.9.21.11.3	SECTION 422.2410	422.2410 General requirements.
42:3.0.1.1.9.21.11.4	SECTION 422.2420	422.2420 Calculation of the medical loss ratio.
42:3.0.1.1.9.21.11.5	SECTION 422.2430	422.2430 Activities that improve health care quality.
42:3.0.1.1.9.21.11.6	SECTION 422.2440	422.2440 Credibility adjustment.
42:3.0.1.1.9.21.11.7	SECTION 422.2450	422.2450 [Reserved]
42:3.0.1.1.9.21.11.8	SECTION 422.2460	422.2460 Reporting requirements.
42:3.0.1.1.9.21.11.9	SECTION 422.2470	422.2470 Remittance to CMS if the applicable MLR requirement is not met.
42:3.0.1.1.9.21.11.10	SECTION 422.2480	422.2480 MLR review and non-compliance.
42:3.0.1.1.9.21.11.11	SECTION 422.2490	422.2490 Release of Part C MLR data.
42:3.0.1.1.9.22	SUBPART Y	Subpart Y [Reserved]
42:3.0.1.1.9.23	SUBPART Z	Subpart Z - Part C Recovery Audit Contractor Appeals Process
42:3.0.1.1.9.23.11.1	SECTION 422.2600	422.2600 Payment appeals.
42:3.0.1.1.9.23.11.2	SECTION 422.2605	422.2605 Request for reconsideration.
42:3.0.1.1.9.23.11.3	SECTION 422.2610	422.2610 Hearing official review.
42:3.0.1.1.9.23.11.4	SECTION 422.2615	422.2615 Review by the Administrator.

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