Subpart M—Grievances, Organization Determinations and Appeals

1. CFR
2. ›
3. Title 42
4. ›
5. Chapter IV
6. ›
7. Part 422
8. ›
9. Subpart M

Contents

• 422.560
  § 422.560 Basis and scope.
• 422.561
  § 422.561 Definitions.
• 422.562
  § 422.562 General provisions.
• 422.564
  § 422.564 Grievance procedures.
• 422.566
  § 422.566 Organization determinations.
• 422.568
  § 422.568 Standard timeframes and notice requirements for organization determinations.
• 422.570
  § 422.570 Expediting certain organization determinations.
• 422.572
  § 422.572 Timeframes and notice requirements for expedited organization determinations.
• 422.574
  § 422.574 Parties to the organization determination.
• 422.576
  § 422.576 Effect of an organization determination.
• 422.578
  § 422.578 Right to a reconsideration.
• 422.580
  § 422.580 Reconsideration defined.
• 422.582
  § 422.582 Request for a standard reconsideration.
• 422.584
  § 422.584 Expediting certain reconsiderations.
• 422.586
  § 422.586 Opportunity to submit evidence.
• 422.590
  § 422.590 Timeframes and responsibility for reconsiderations.
• 422.592
  § 422.592 Reconsideration by an independent entity.
• 422.594
  § 422.594 Notice of reconsidered determination by the independent entity.
• 422.596
  § 422.596 Effect of a reconsidered determination.
• 422.600
  § 422.600 Right to a hearing.
• 422.602
  § 422.602 Request for an ALJ hearing.
• 422.608
  § 422.608 Medicare Appeals Council (Council) review.
• 422.612
  § 422.612 Judicial review.
• 422.616
  § 422.616 Reopening and revising determinations and decisions.
• 422.618
  § 422.618 How an MA organization must effectuate standard reconsidered determinations or decisions.
• 422.619
  § 422.619 How an MA organization must effectuate expedited reconsidered determinations.
• 422.620
  § 422.620 Notifying enrollees of hospital discharge appeal rights.
• 422.622
  § 422.622 Requesting immediate QIO review of the decision to discharge from the inpatient hospital.
• 422.624
  § 422.624 Notifying enrollees of termination of provider services.
• 422.626
  § 422.626 Fast-track appeals of service terminations to independent review entities (IREs).
• Requirements Applicable to Certain Integrated Dual Eligible Special Needs Plans
  Requirements Applicable to Certain Integrated Dual Eligible Special Needs Plans Sections 422.629–422.634