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.

42:3.0.1.1.9.1SUBPART A
Subpart A - General Provisions
42:3.0.1.1.9.1.9.1SECTION 422.1
   422.1 Basis and scope.
42:3.0.1.1.9.1.9.2SECTION 422.2
   422.2 Definitions.
42:3.0.1.1.9.1.9.3SECTION 422.3
   422.3 xxx
42:3.0.1.1.9.1.9.4SECTION 422.4
   422.4 Types of MA plans.
42:3.0.1.1.9.1.9.5SECTION 422.6
   422.6 Cost-sharing in enrollment-related costs.
42:3.0.1.1.9.2SUBPART B
Subpart B - Eligibility, Election, and Enrollment
42:3.0.1.1.9.2.9.1SECTION 422.50
   422.50 Eligibility to elect an MA plan.
42:3.0.1.1.9.2.9.2SECTION 422.52
   422.52 Eligibility to elect an MA plan for special needs individuals.
42:3.0.1.1.9.2.9.3SECTION 422.53
   422.53 Eligibility to elect an MA plan for senior housing facility residents.
42:3.0.1.1.9.2.9.4SECTION 422.54
   422.54 Continuation of enrollment for MA local plans.
42:3.0.1.1.9.2.9.5SECTION 422.56
   422.56 Enrollment in an MA MSA plan.
42:3.0.1.1.9.2.9.6SECTION 422.57
   422.57 Limited enrollment under MA RFB plans.
42:3.0.1.1.9.2.9.7SECTION 422.60
   422.60 Election process.
42:3.0.1.1.9.2.9.8SECTION 422.62
   422.62 Election of coverage under an MA plan.
42:3.0.1.1.9.2.9.9SECTION 422.64
   422.64 Information about the MA program.
42:3.0.1.1.9.2.9.10SECTION 422.66
   422.66 Coordination of enrollment and disenrollment through MA organizations.
42:3.0.1.1.9.2.9.11SECTION 422.68
   422.68 Effective dates of coverage and change of coverage.
42:3.0.1.1.9.2.9.12SECTION 422.74
   422.74 Disenrollment by the MA organization.
42:3.0.1.1.9.3SUBPART C
Subpart C - Benefits and Beneficiary Protections
42:3.0.1.1.9.3.9.1SECTION 422.100
   422.100 General requirements.
42:3.0.1.1.9.3.9.2SECTION 422.101
   422.101 Requirements relating to basic benefits.
42:3.0.1.1.9.3.9.3SECTION 422.102
   422.102 Supplemental benefits.
42:3.0.1.1.9.3.9.4SECTION 422.103
   422.103 Benefits under an MA MSA plan.
42:3.0.1.1.9.3.9.5SECTION 422.104
   422.104 Special rules on supplemental benefits for MA MSA plans.
42:3.0.1.1.9.3.9.6SECTION 422.105
   422.105 Special rules for self-referral and point of service option.
42:3.0.1.1.9.3.9.7SECTION 422.106
   422.106 Coordination of benefits with employer or union group health plans and Medicaid.
42:3.0.1.1.9.3.9.8SECTION 422.107
   422.107 Special needs plans and dual eligibles: Contract with State Medicaid Agency.
42:3.0.1.1.9.3.9.9SECTION 422.108
   422.108 Medicare secondary payer (MSP) procedures.
42:3.0.1.1.9.3.9.10SECTION 422.109
   422.109 Effect of national coverage determinations (NCDs) and legislative changes in benefits.
42:3.0.1.1.9.3.9.11SECTION 422.110
   422.110 Discrimination against beneficiaries prohibited.
42:3.0.1.1.9.3.9.12SECTION 422.111
   422.111 Disclosure requirements.
42:3.0.1.1.9.3.9.13SECTION 422.112
   422.112 Access to services.
42:3.0.1.1.9.3.9.14SECTION 422.113
   422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance and post-stabilization care services.
42:3.0.1.1.9.3.9.15SECTION 422.114
   422.114 Access to services under an MA private fee-for-service plan.
42:3.0.1.1.9.3.9.16SECTION 422.116
   422.116 xxx
42:3.0.1.1.9.3.9.17SECTION 422.118
   422.118 Confidentiality and accuracy of enrollee records.
42:3.0.1.1.9.3.9.18SECTION 422.119
   422.119 xxx
42:3.0.1.1.9.3.9.19SECTION 422.120
   422.120 xxx
42:3.0.1.1.9.3.9.20SECTION 422.128
   422.128 Information on advance directives.
42:3.0.1.1.9.3.9.21SECTION 422.132
   422.132 Protection against liability and loss of benefits.
42:3.0.1.1.9.3.9.22SECTION 422.133
   422.133 Return to home skilled nursing facility.
42:3.0.1.1.9.3.9.23SECTION 422.134
   422.134 Reward and incentive programs.
42:3.0.1.1.9.3.9.24SECTION 422.135
   422.135 Additional telehealth benefits.
42:3.0.1.1.9.3.9.25SECTION 422.136
   422.136 Medicare Advantage (MA) and step therapy for Part B drugs.
42:3.0.1.1.9.4SUBPART D
Subpart D - Quality Improvement
42:3.0.1.1.9.4.9.1SECTION 422.152
   422.152 Quality improvement program.
42:3.0.1.1.9.4.9.2SECTION 422.153
   422.153 Use of quality improvement organization review information.
42:3.0.1.1.9.4.9.3SECTION 422.156
   422.156 Compliance deemed on the basis of accreditation.
42:3.0.1.1.9.4.9.4SECTION 422.157
   422.157 Accreditation organizations.
42:3.0.1.1.9.4.9.5SECTION 422.158
   422.158 Procedures for approval of accreditation as a basis for deeming compliance.
42:3.0.1.1.9.4.9.6SECTION 422.160
   422.160 Basis and scope of the Medicare Advantage Quality Rating System.
42:3.0.1.1.9.4.9.7SECTION 422.162
   422.162 Medicare Advantage Quality Rating System.
42:3.0.1.1.9.4.9.8SECTION 422.164
   422.164 Adding, updating, and removing measures.
42:3.0.1.1.9.4.9.9SECTION 422.166
   422.166 Calculation of Star Ratings.
42:3.0.1.1.9.5SUBPART E
Subpart E - Relationships With Providers
42:3.0.1.1.9.5.9.1SECTION 422.200
   422.200 Basis and scope.
42:3.0.1.1.9.5.9.2SECTION 422.202
   422.202 Participation procedures.
42:3.0.1.1.9.5.9.3SECTION 422.204
   422.204 Provider selection and credentialing.
42:3.0.1.1.9.5.9.4SECTION 422.205
   422.205 Provider antidiscrimination rules.
42:3.0.1.1.9.5.9.5SECTION 422.206
   422.206 Interference with health care professionals' advice to enrollees prohibited.
42:3.0.1.1.9.5.9.6SECTION 422.208
   422.208 Physician incentive plans: requirements and limitations.
42:3.0.1.1.9.5.9.7SECTION 422.210
   422.210 Assurances to CMS.
42:3.0.1.1.9.5.9.8SECTION 422.212
   422.212 Limitations on provider indemnification.
42:3.0.1.1.9.5.9.9SECTION 422.214
   422.214 Special rules for services furnished by noncontract providers.
42:3.0.1.1.9.5.9.10SECTION 422.216
   422.216 Special rules for MA private fee-for-service plans.
42:3.0.1.1.9.5.9.11SECTION 422.220
   422.220 Exclusion of services furnished under a private contract.
42:3.0.1.1.9.5.9.12SECTION 422.222
   422.222 Preclusion list for contracted and non-contracted individuals and entities.
42:3.0.1.1.9.5.9.13SECTION 422.224
   422.224 Payment to individuals and entities excluded by the OIG or included on the preclusion list.
42:3.0.1.1.9.6SUBPART F
Subpart F - Submission of Bids, Premiums, and Related Information and Plan Approval
42:3.0.1.1.9.6.9.1SECTION 422.250
   422.250 Basis and scope.
42:3.0.1.1.9.6.9.2SECTION 422.252
   422.252 Terminology.
42:3.0.1.1.9.6.9.3SECTION 422.254
   422.254 Submission of bids.
42:3.0.1.1.9.6.9.4SECTION 422.256
   422.256 Review, negotiation, and approval of bids.
42:3.0.1.1.9.6.9.5SECTION 422.258
   422.258 Calculation of benchmarks.
42:3.0.1.1.9.6.9.6SECTION 422.260
   422.260 Appeals of quality bonus payment determinations.
42:3.0.1.1.9.6.9.7SECTION 422.262
   422.262 Beneficiary premiums.
42:3.0.1.1.9.6.9.8SECTION 422.264
   422.264 Calculation of savings.
42:3.0.1.1.9.6.9.9SECTION 422.266
   422.266 Beneficiary rebates.
42:3.0.1.1.9.6.9.10SECTION 422.270
   422.270 Incorrect collections of premiums and cost-sharing.
42:3.0.1.1.9.6.9.11SECTION 422.272
   422.272 Release of MA bid pricing data.
42:3.0.1.1.9.7SUBPART G
Subpart G - Payments to Medicare Advantage Organizations
42:3.0.1.1.9.7.9.1SECTION 422.300
   422.300 Basis and scope.
42:3.0.1.1.9.7.9.2SECTION 422.304
   422.304 Monthly payments.
42:3.0.1.1.9.7.9.3SECTION 422.306
   422.306 Annual MA capitation rates.
42:3.0.1.1.9.7.9.4SECTION 422.308
   422.308 Adjustments to capitation rates, benchmarks, bids, and payments.
42:3.0.1.1.9.7.9.5SECTION 422.310
   422.310 Risk adjustment data.
42:3.0.1.1.9.7.9.6SECTION 422.311
   422.311 RADV audit dispute and appeal processes.
42:3.0.1.1.9.7.9.7SECTION 422.312
   422.312 Announcement of annual capitation rate, benchmarks, and methodology changes.
42:3.0.1.1.9.7.9.8SECTION 422.314
   422.314 Special rules for beneficiaries enrolled in MA MSA plans.
42:3.0.1.1.9.7.9.9SECTION 422.316
   422.316 Special rules for payments to Federally qualified health centers.
42:3.0.1.1.9.7.9.10SECTION 422.318
   422.318 Special rules for coverage that begins or ends during an inpatient hospital stay.
42:3.0.1.1.9.7.9.11SECTION 422.320
   422.320 Special rules for hospice care.
42:3.0.1.1.9.7.9.12SECTION 422.322
   422.322 Source of payment and effect of MA plan election on payment.
42:3.0.1.1.9.7.9.13SECTION 422.324
   422.324 Payments to MA organizations for graduate medical education costs.
42:3.0.1.1.9.7.9.14SECTION 422.326
   422.326 Reporting and returning of overpayments.
42:3.0.1.1.9.7.9.15SECTION 422.330
   422.330 CMS-identified overpayments associated with payment data submitted by MA organizations.
42:3.0.1.1.9.8SUBPART H
Subpart H - Provider-Sponsored Organizations
42:3.0.1.1.9.8.9.1SECTION 422.350
   422.350 Basis, scope, and definitions.
42:3.0.1.1.9.8.9.2SECTION 422.352
   422.352 Basic requirements.
42:3.0.1.1.9.8.9.3SECTION 422.354
   422.354 Requirements for affiliated providers.
42:3.0.1.1.9.8.9.4SECTION 422.356
   422.356 Determining substantial financial risk and majority financial interest.
42:3.0.1.1.9.8.9.5SECTION 422.370
   422.370 Waiver of State licensure.
42:3.0.1.1.9.8.9.6SECTION 422.372
   422.372 Basis for waiver of State licensure.
42:3.0.1.1.9.8.9.7SECTION 422.374
   422.374 Waiver request and approval process.
42:3.0.1.1.9.8.9.8SECTION 422.376
   422.376 Conditions of the waiver.
42:3.0.1.1.9.8.9.9SECTION 422.378
   422.378 Relationship to State law.
42:3.0.1.1.9.8.9.10SECTION 422.380
   422.380 Solvency standards.
42:3.0.1.1.9.8.9.11SECTION 422.382
   422.382 Minimum net worth amount.
42:3.0.1.1.9.8.9.12SECTION 422.384
   422.384 Financial plan requirement.
42:3.0.1.1.9.8.9.13SECTION 422.386
   422.386 Liquidity.
42:3.0.1.1.9.8.9.14SECTION 422.388
   422.388 Deposits.
42:3.0.1.1.9.8.9.15SECTION 422.390
   422.390 Guarantees.
42:3.0.1.1.9.9SUBPART I
Subpart I - Organization Compliance With State Law and Preemption by Federal Law
42:3.0.1.1.9.9.9.1SECTION 422.400
   422.400 State licensure requirement.
42:3.0.1.1.9.9.9.2SECTION 422.402
   422.402 Federal preemption of State law.
42:3.0.1.1.9.9.9.3SECTION 422.404
   422.404 State premium taxes prohibited.
42:3.0.1.1.9.10SUBPART J
Subpart J - Special Rules for MA Regional Plans
42:3.0.1.1.9.10.9.1SECTION 422.451
   422.451 Moratorium on new local preferred provider organization plans.
42:3.0.1.1.9.10.9.2SECTION 422.455
   422.455 Special rules for MA Regional Plans.
42:3.0.1.1.9.10.9.3SECTION 422.458
   422.458 Risk sharing with regional MA organizations for 2006 and 2007.
42:3.0.1.1.9.11SUBPART K
Subpart K - Application Procedures and Contracts for Medicare Advantage Organizations
42:3.0.1.1.9.11.9.1SECTION 422.500
   422.500 Scope and definitions.
42:3.0.1.1.9.11.9.2SECTION 422.501
   422.501 Application requirements.
42:3.0.1.1.9.11.9.3SECTION 422.502
   422.502 Evaluation and determination procedures.
42:3.0.1.1.9.11.9.4SECTION 422.503
   422.503 General provisions.
42:3.0.1.1.9.11.9.5SECTION 422.504
   422.504 Contract provisions.
42:3.0.1.1.9.11.9.6SECTION 422.505
   422.505 Effective date and term of contract.
42:3.0.1.1.9.11.9.7SECTION 422.506
   422.506 Nonrenewal of contract.
42:3.0.1.1.9.11.9.8SECTION 422.508
   422.508 Modification or termination of contract by mutual consent.
42:3.0.1.1.9.11.9.9SECTION 422.510
   422.510 Termination of contract by CMS.
42:3.0.1.1.9.11.9.10SECTION 422.512
   422.512 Termination of contract by the MA organization.
42:3.0.1.1.9.11.9.11SECTION 422.514
   422.514 Minimum enrollment requirements.
42:3.0.1.1.9.11.9.12SECTION 422.516
   422.516 Validation of Part C reporting requirements.
42:3.0.1.1.9.11.9.13SECTION 422.520
   422.520 Prompt payment by MA organization.
42:3.0.1.1.9.11.9.14SECTION 422.521
   422.521 Effective date of new significant regulatory requirements.
42:3.0.1.1.9.11.9.15SECTION 422.524
   422.524 Special rules for RFB societies.
42:3.0.1.1.9.11.9.16SECTION 422.527
   422.527 Agreements with Federally qualified health centers.
42:3.0.1.1.9.12SUBPART L
Subpart L - Effect of Change of Ownership or Leasing of Facilities During Term of Contract
42:3.0.1.1.9.12.9.1SECTION 422.550
   422.550 General provisions.
42:3.0.1.1.9.12.9.2SECTION 422.552
   422.552 Novation agreement requirements.
42:3.0.1.1.9.12.9.3SECTION 422.553
   422.553 Effect of leasing of an MA organization's facilities.
42:3.0.1.1.9.13SUBPART M
Subpart M - Grievances, Organization Determinations and Appeals
42:3.0.1.1.9.13.9.1SECTION 422.560
   422.560 Basis and scope.
42:3.0.1.1.9.13.9.2SECTION 422.561
   422.561 Definitions.
42:3.0.1.1.9.13.9.3SECTION 422.562
   422.562 General provisions.
42:3.0.1.1.9.13.9.4SECTION 422.564
   422.564 Grievance procedures.
42:3.0.1.1.9.13.9.5SECTION 422.566
   422.566 Organization determinations.
42:3.0.1.1.9.13.9.6SECTION 422.568
   422.568 Standard timeframes and notice requirements for organization determinations.
42:3.0.1.1.9.13.9.7SECTION 422.570
   422.570 Expediting certain organization determinations.
42:3.0.1.1.9.13.9.8SECTION 422.572
   422.572 Timeframes and notice requirements for expedited organization determinations.
42:3.0.1.1.9.13.9.9SECTION 422.574
   422.574 Parties to the organization determination.
42:3.0.1.1.9.13.9.10SECTION 422.576
   422.576 Effect of an organization determination.
42:3.0.1.1.9.13.9.11SECTION 422.578
   422.578 Right to a reconsideration.
42:3.0.1.1.9.13.9.12SECTION 422.580
   422.580 Reconsideration defined.
42:3.0.1.1.9.13.9.13SECTION 422.582
   422.582 Request for a standard reconsideration.
42:3.0.1.1.9.13.9.14SECTION 422.584
   422.584 Expediting certain reconsiderations.
42:3.0.1.1.9.13.9.15SECTION 422.586
   422.586 Opportunity to submit evidence.
42:3.0.1.1.9.13.9.16SECTION 422.590
   422.590 Timeframes and responsibility for reconsiderations.
42:3.0.1.1.9.13.9.17SECTION 422.592
   422.592 Reconsideration by an independent entity.
42:3.0.1.1.9.13.9.18SECTION 422.594
   422.594 Notice of reconsidered determination by the independent entity.
42:3.0.1.1.9.13.9.19SECTION 422.596
   422.596 Effect of a reconsidered determination.
42:3.0.1.1.9.13.9.20SECTION 422.600
   422.600 Right to a hearing.
42:3.0.1.1.9.13.9.21SECTION 422.602
   422.602 Request for an ALJ hearing.
42:3.0.1.1.9.13.9.22SECTION 422.608
   422.608 Medicare Appeals Council (Council) review.
42:3.0.1.1.9.13.9.23SECTION 422.612
   422.612 Judicial review.
42:3.0.1.1.9.13.9.24SECTION 422.616
   422.616 Reopening and revising determinations and decisions.
42:3.0.1.1.9.13.9.25SECTION 422.618
   422.618 How an MA organization must effectuate standard reconsidered determinations or decisions.
42:3.0.1.1.9.13.9.26SECTION 422.619
   422.619 How an MA organization must effectuate expedited reconsidered determinations.
42:3.0.1.1.9.13.9.27SECTION 422.620
   422.620 Notifying enrollees of hospital discharge appeal rights.
42:3.0.1.1.9.13.9.28SECTION 422.622
   422.622 Requesting immediate QIO review of the decision to discharge from the inpatient hospital.
42:3.0.1.1.9.13.9.29SECTION 422.624
   422.624 Notifying enrollees of termination of provider services.
42:3.0.1.1.9.13.9.30SECTION 422.626
   422.626 Fast-track appeals of service terminations to independent review entities (IREs).
42:3.0.1.1.9.13.9.31SECTION 422.629
   422.629 xxx
42:3.0.1.1.9.13.9.32SECTION 422.630
   422.630 xxx
42:3.0.1.1.9.13.9.33SECTION 422.631
   422.631 xxx
42:3.0.1.1.9.13.9.34SECTION 422.632
   422.632 xxx
42:3.0.1.1.9.13.9.35SECTION 422.633
   422.633 xxx
42:3.0.1.1.9.13.9.36SECTION 422.634
   422.634 xxx
42:3.0.1.1.9.14SUBPART N
Subpart N - Medicare Contract Determinations and Appeals
42:3.0.1.1.9.14.9.1SECTION 422.641
   422.641 Contract determinations.
42:3.0.1.1.9.14.9.2SECTION 422.644
   422.644 Notice of contract determination.
42:3.0.1.1.9.14.9.3SECTION 422.646
   422.646 Effect of contract determination.
42:3.0.1.1.9.14.9.4SECTION 422.660
   422.660 Right to a hearing, burden of proof, standard of proof, and standards of review.
42:3.0.1.1.9.14.9.5SECTION 422.662
   422.662 Request for hearing.
42:3.0.1.1.9.14.9.6SECTION 422.664
   422.664 Postponement of effective date of a contract determination when a request for a hearing is filed timely.
42:3.0.1.1.9.14.9.7SECTION 422.666
   422.666 Designation of hearing officer.
42:3.0.1.1.9.14.9.8SECTION 422.668
   422.668 Disqualification of hearing officer.
42:3.0.1.1.9.14.9.9SECTION 422.670
   422.670 Time and place of hearing.
42:3.0.1.1.9.14.9.10SECTION 422.672
   422.672 Appointment of representatives.
42:3.0.1.1.9.14.9.11SECTION 422.674
   422.674 Authority of representatives.
42:3.0.1.1.9.14.9.12SECTION 422.676
   422.676 Conduct of hearing.
42:3.0.1.1.9.14.9.13SECTION 422.678
   422.678 Evidence.
42:3.0.1.1.9.14.9.14SECTION 422.680
   422.680 Witnesses.
42:3.0.1.1.9.14.9.15SECTION 422.682
   422.682 Witness lists and documents.
42:3.0.1.1.9.14.9.16SECTION 422.684
   422.684 Prehearing and summary judgment.
42:3.0.1.1.9.14.9.17SECTION 422.686
   422.686 Record of hearing.
42:3.0.1.1.9.14.9.18SECTION 422.688
   422.688 Authority of hearing officer.
42:3.0.1.1.9.14.9.19SECTION 422.690
   422.690 Notice and effect of hearing decision.
42:3.0.1.1.9.14.9.20SECTION 422.692
   422.692 Review by the Administrator.
42:3.0.1.1.9.14.9.21SECTION 422.694
   422.694 Effect of Administrator's decision.
42:3.0.1.1.9.14.9.22SECTION 422.696
   422.696 Reopening of a contract determination or decision of a hearing officer or the Administrator.
42:3.0.1.1.9.15SUBPART O
Subpart O - Intermediate Sanctions
42:3.0.1.1.9.15.9.1SECTION 422.750
   422.750 Types of intermediate sanctions and civil money penalties.
42:3.0.1.1.9.15.9.2SECTION 422.752
   422.752 Basis for imposing intermediate sanctions and civil money penalties.
42:3.0.1.1.9.15.9.3SECTION 422.756
   422.756 Procedures for imposing intermediate sanctions and civil money penalties.
42:3.0.1.1.9.15.9.4SECTION 422.758
   422.758 Collection of civil money penalties imposed by CMS.
42:3.0.1.1.9.15.9.5SECTION 422.760
   422.760 Determinations regarding the amount of civil money penalties and assessment imposed by CMS.
42:3.0.1.1.9.15.9.6SECTION 422.762
   422.762 Settlement of penalties.
42:3.0.1.1.9.15.9.7SECTION 422.764
   422.764 Other applicable provisions.
42:3.0.1.1.9.16SUBPART P
Subparts P-S [Reserved]
42:3.0.1.1.9.17SUBPART T
Subpart T - Appeal procedures for Civil Money Penalties
42:3.0.1.1.9.17.9.1SECTION 422.1000
   422.1000 Basis and scope.
42:3.0.1.1.9.17.9.2SECTION 422.1002
   422.1002 Definitions.
42:3.0.1.1.9.17.9.3SECTION 422.1004
   422.1004 Scope and applicability.
42:3.0.1.1.9.17.9.4SECTION 422.1006
   422.1006 Appeal rights.
42:3.0.1.1.9.17.9.5SECTION 422.1008
   422.1008 Appointment of representatives.
42:3.0.1.1.9.17.9.6SECTION 422.1010
   422.1010 Authority of representatives.
42:3.0.1.1.9.17.9.7SECTION 422.1012
   422.1012 Fees for services of representatives.
42:3.0.1.1.9.17.9.8SECTION 422.1014
   422.1014 Charge for transcripts.
42:3.0.1.1.9.17.9.9SECTION 422.1016
   422.1016 Filing of briefs with the Administrative Law Judge or Departmental Appeals Board, and opportunity for rebuttal.
42:3.0.1.1.9.17.9.10SECTION 422.1018
   422.1018 Notice and effect of initial determinations.
42:3.0.1.1.9.17.9.11SECTION 422.1020
   422.1020 Request for hearing.
42:3.0.1.1.9.17.9.12SECTION 422.1022
   422.1022 Parties to the hearing.
42:3.0.1.1.9.17.9.13SECTION 422.1024
   422.1024 Designation of hearing official.
42:3.0.1.1.9.17.9.14SECTION 422.1026
   422.1026 Disqualification of Administrative Law Judge.
42:3.0.1.1.9.17.9.15SECTION 422.1028
   422.1028 Prehearing conference.
42:3.0.1.1.9.17.9.16SECTION 422.1030
   422.1030 Notice of prehearing conference.
42:3.0.1.1.9.17.9.17SECTION 422.1032
   422.1032 Conduct of prehearing conference.
42:3.0.1.1.9.17.9.18SECTION 422.1034
   422.1034 Record, order, and effect of prehearing conference.
42:3.0.1.1.9.17.9.19SECTION 422.1036
   422.1036 Time and place of hearing.
42:3.0.1.1.9.17.9.20SECTION 422.1038
   422.1038 Change in time and place of hearing.
42:3.0.1.1.9.17.9.21SECTION 422.1040
   422.1040 Joint hearings.
42:3.0.1.1.9.17.9.22SECTION 422.1042
   422.1042 Hearing on new issues.
42:3.0.1.1.9.17.9.23SECTION 422.1044
   422.1044 Subpoenas.
42:3.0.1.1.9.17.9.24SECTION 422.1046
   422.1046 Conduct of hearing.
42:3.0.1.1.9.17.9.25SECTION 422.1048
   422.1048 Evidence.
42:3.0.1.1.9.17.9.26SECTION 422.1050
   422.1050 Witnesses.
42:3.0.1.1.9.17.9.27SECTION 422.1052
   422.1052 Oral and written summation.
42:3.0.1.1.9.17.9.28SECTION 422.1054
   422.1054 Record of hearing.
42:3.0.1.1.9.17.9.29SECTION 422.1056
   422.1056 Waiver of right to appear and present evidence.
42:3.0.1.1.9.17.9.30SECTION 422.1058
   422.1058 Dismissal of request for hearing.
42:3.0.1.1.9.17.9.31SECTION 422.1060
   422.1060 Dismissal for abandonment.
42:3.0.1.1.9.17.9.32SECTION 422.1062
   422.1062 Dismissal for cause.
42:3.0.1.1.9.17.9.33SECTION 422.1064
   422.1064 Notice and effect of dismissal and right to request review.
42:3.0.1.1.9.17.9.34SECTION 422.1066
   422.1066 Vacating a dismissal of request for hearing.
42:3.0.1.1.9.17.9.35SECTION 422.1068
   422.1068 Administrative Law Judge's decision.
42:3.0.1.1.9.17.9.36SECTION 422.1070
   422.1070 Removal of hearing to Departmental Appeals Board.
42:3.0.1.1.9.17.9.37SECTION 422.1072
   422.1072 Remand by the Administrative Law Judge.
42:3.0.1.1.9.17.9.38SECTION 422.1074
   422.1074 Right to request Departmental Appeals Board review of Administrative Law Judge's decision or dismissal.
42:3.0.1.1.9.17.9.39SECTION 422.1076
   422.1076 Request for Departmental Appeals Board review.
42:3.0.1.1.9.17.9.40SECTION 422.1078
   422.1078 Departmental Appeals Board action on request for review.
42:3.0.1.1.9.17.9.41SECTION 422.1080
   422.1080 Procedures before the Departmental Appeals Board on review.
42:3.0.1.1.9.17.9.42SECTION 422.1082
   422.1082 Evidence admissible on review.
42:3.0.1.1.9.17.9.43SECTION 422.1084
   422.1084 Decision or remand by the Departmental Appeals Board.
42:3.0.1.1.9.17.9.44SECTION 422.1086
   422.1086 Effect of Departmental Appeals Board Decision.
42:3.0.1.1.9.17.9.45SECTION 422.1088
   422.1088 Extension of time for seeking judicial review.
42:3.0.1.1.9.17.9.46SECTION 422.1090
   422.1090 Basis, timing, and authority for reopening an Administrative Law Judge or Board decision.
42:3.0.1.1.9.17.9.47SECTION 422.1092
   422.1092 Revision of reopened decision.
42:3.0.1.1.9.17.9.48SECTION 422.1094
   422.1094 Notice and effect of revised decision.
42:3.0.1.1.9.18SUBPART U
Subpart U [Reserved]
42:3.0.1.1.9.19SUBPART V
Subpart V - Medicare Advantage Communication Requirements
42:3.0.1.1.9.19.9.1SECTION 422.2260
   422.2260 Definitions.
42:3.0.1.1.9.19.9.2SECTION 422.2262
   422.2262 Review and distribution of marketing materials.
42:3.0.1.1.9.19.9.3SECTION 422.2264
   422.2264 Guidelines for CMS review.
42:3.0.1.1.9.19.9.4SECTION 422.2266
   422.2266 [Reserved]
42:3.0.1.1.9.19.9.5SECTION 422.2268
   422.2268 Standards for MA organization communications and marketing.
42:3.0.1.1.9.19.9.6SECTION 422.2272
   422.2272 Licensing of marketing representatives and confirmation of marketing resources.
42:3.0.1.1.9.19.9.7SECTION 422.2274
   422.2274 Broker and agent requirements.
42:3.0.1.1.9.19.9.8SECTION 422.2276
   422.2276 Employer group retiree marketing.
42:3.0.1.1.9.20SUBPART W
Subpart W [Reserved]
42:3.0.1.1.9.21SUBPART X
Subpart X - Requirements for a Minimum Medical Loss Ratio
42:3.0.1.1.9.21.9.1SECTION 422.2400
   422.2400 Basis and scope.
42:3.0.1.1.9.21.9.2SECTION 422.2401
   422.2401 Definitions.
42:3.0.1.1.9.21.9.3SECTION 422.2410
   422.2410 General requirements.
42:3.0.1.1.9.21.9.4SECTION 422.2420
   422.2420 Calculation of the medical loss ratio.
42:3.0.1.1.9.21.9.5SECTION 422.2430
   422.2430 Activities that improve health care quality.
42:3.0.1.1.9.21.9.6SECTION 422.2440
   422.2440 Credibility adjustment.
42:3.0.1.1.9.21.9.7SECTION 422.2450
   422.2450 [Reserved]
42:3.0.1.1.9.21.9.8SECTION 422.2460
   422.2460 Reporting requirements.
42:3.0.1.1.9.21.9.9SECTION 422.2470
   422.2470 Remittance to CMS if the applicable MLR requirement is not met.
42:3.0.1.1.9.21.9.10SECTION 422.2480
   422.2480 MLR review and non-compliance.
42:3.0.1.1.9.21.9.11SECTION 422.2490
   422.2490 Release of Part C MLR data.
42:3.0.1.1.9.22SUBPART Y
Subpart Y [Reserved]
42:3.0.1.1.9.23SUBPART Z
Subpart Z - Part C Recovery Audit Contractor Appeals Process
42:3.0.1.1.9.23.9.1SECTION 422.2600
   422.2600 Payment appeals.
42:3.0.1.1.9.23.9.2SECTION 422.2605
   422.2605 Request for reconsideration.
42:3.0.1.1.9.23.9.3SECTION 422.2610
   422.2610 Hearing official review.
42:3.0.1.1.9.23.9.4SECTION 422.2615
   422.2615 Review by the Administrator.