Title 42

PART 422 SUBPART M

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

42:3.0.1.1.9.13.10SUBJGRP 10
Requirements Applicable to Certain Integrated Dual Eligible Special Needs Plans
42:3.0.1.1.9.13.10.1SECTION 422.560
   422.560 Basis and scope.
42:3.0.1.1.9.13.10.2SECTION 422.561
   422.561 Definitions.
42:3.0.1.1.9.13.10.3SECTION 422.562
   422.562 General provisions.
42:3.0.1.1.9.13.10.4SECTION 422.564
   422.564 Grievance procedures.
42:3.0.1.1.9.13.10.5SECTION 422.566
   422.566 Organization determinations.
42:3.0.1.1.9.13.10.6SECTION 422.568
   422.568 Standard timeframes and notice requirements for organization determinations.
42:3.0.1.1.9.13.10.7SECTION 422.570
   422.570 Expediting certain organization determinations.
42:3.0.1.1.9.13.10.8SECTION 422.572
   422.572 Timeframes and notice requirements for expedited organization determinations.
42:3.0.1.1.9.13.10.9SECTION 422.574
   422.574 Parties to the organization determination.
42:3.0.1.1.9.13.10.10SECTION 422.576
   422.576 Effect of an organization determination.
42:3.0.1.1.9.13.10.11SECTION 422.578
   422.578 Right to a reconsideration.
42:3.0.1.1.9.13.10.12SECTION 422.580
   422.580 Reconsideration defined.
42:3.0.1.1.9.13.10.13SECTION 422.582
   422.582 Request for a standard reconsideration.
42:3.0.1.1.9.13.10.14SECTION 422.584
   422.584 Expediting certain reconsiderations.
42:3.0.1.1.9.13.10.15SECTION 422.586
   422.586 Opportunity to submit evidence.
42:3.0.1.1.9.13.10.16SECTION 422.590
   422.590 Timeframes and responsibility for reconsiderations.
42:3.0.1.1.9.13.10.17SECTION 422.592
   422.592 Reconsideration by an independent entity.
42:3.0.1.1.9.13.10.18SECTION 422.594
   422.594 Notice of reconsidered determination by the independent entity.
42:3.0.1.1.9.13.10.19SECTION 422.596
   422.596 Effect of a reconsidered determination.
42:3.0.1.1.9.13.10.20SECTION 422.600
   422.600 Right to a hearing.
42:3.0.1.1.9.13.10.21SECTION 422.602
   422.602 Request for an ALJ hearing.
42:3.0.1.1.9.13.10.22SECTION 422.608
   422.608 Medicare Appeals Council (Council) review.
42:3.0.1.1.9.13.10.23SECTION 422.612
   422.612 Judicial review.
42:3.0.1.1.9.13.10.24SECTION 422.616
   422.616 Reopening and revising determinations and decisions.
42:3.0.1.1.9.13.10.25SECTION 422.618
   422.618 How an MA organization must effectuate standard reconsidered determinations or decisions.
42:3.0.1.1.9.13.10.26SECTION 422.619
   422.619 How an MA organization must effectuate expedited reconsidered determinations.
42:3.0.1.1.9.13.10.27SECTION 422.620
   422.620 Notifying enrollees of hospital discharge appeal rights.
42:3.0.1.1.9.13.10.28SECTION 422.622
   422.622 Requesting immediate QIO review of the decision to discharge from the inpatient hospital.
42:3.0.1.1.9.13.10.29SECTION 422.624
   422.624 Notifying enrollees of termination of provider services.
42:3.0.1.1.9.13.10.30SECTION 422.626
   422.626 Fast-track appeals of service terminations to independent review entities (IREs).
42:3.0.1.1.9.13.10.31SECTION 422.629
   422.629 General requirements for applicable integrated plans.
42:3.0.1.1.9.13.10.32SECTION 422.630
   422.630 Integrated grievances.
42:3.0.1.1.9.13.10.33SECTION 422.631
   422.631 Integrated organization determinations.
42:3.0.1.1.9.13.10.34SECTION 422.632
   422.632 Continuation of benefits while the applicable integrated plan reconsideration is pending.
42:3.0.1.1.9.13.10.35SECTION 422.633
   422.633 Integrated reconsideration.
42:3.0.1.1.9.13.10.36SECTION 422.634
   422.634 Effect.