Title 42

PART 422 SUBPART M

Subpart M - Grievances, Organization Determinations and Appeals Source:63 FR 35107, June 26, 1998, unless otherwise noted.

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

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.

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