Subpart M—Grievances, Coverage Determinations, Redeterminations, and Reconsiderations

Sections

• 423.558
  § 423.558 Scope.
• 423.560
  § 423.560 Definitions.
• 423.562
  § 423.562 General provisions.
• 423.564
  § 423.564 Grievance procedures.
• 423.566
  § 423.566 Coverage determinations.
• 423.568
  § 423.568 Standard timeframe and notice requirements for coverage determinations.
• 423.570
  § 423.570 Expediting certain coverage determinations.
• 423.572
  § 423.572 Timeframes and notice requirements for expedited coverage determinations.
• 423.576
  § 423.576 Effect of a coverage determination.
• 423.578
  § 423.578 Exceptions process.
• 423.580
  § 423.580 Right to a redetermination.
• 423.582
  § 423.582 Request for a standard redetermination.
• 423.584
  § 423.584 Expediting certain redeterminations.
• 423.586
  § 423.586 Opportunity to submit evidence.
• 423.590
  § 423.590 Timeframes and responsibility for making redeterminations.
• 423.600
  § 423.600 Reconsideration by an independent review entity (IRE).
• 423.602
  § 423.602 Notice of reconsideration determination by the independent review entity.
• 423.604
  § 423.604 Effect of a reconsideration determination.
• 423.610-423.634
  §§ 423.610-423.634 [Reserved]
• 423.636
  § 423.636 How a Part D plan sponsor must effectuate standard redeterminations, reconsiderations, or decisions.
• 423.638
  § 423.638 How a Part D plan sponsor must effectuate expedited redeterminations or reconsiderations.