Title 42

PART 423 SUBPART M

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

• 42 U.S.C. 1302, 1306, 1395w-101 through 1395w-152, and 1395hh.
• 70 FR 4525, Jan. 28, 2005, unless otherwise noted.

42:3.0.1.1.10.13.11.1	SECTION 423.558	423.558 Scope.
42:3.0.1.1.10.13.11.2	SECTION 423.560	423.560 Definitions.
42:3.0.1.1.10.13.11.3	SECTION 423.562	423.562 General provisions.
42:3.0.1.1.10.13.11.4	SECTION 423.564	423.564 Grievance procedures.
42:3.0.1.1.10.13.11.5	SECTION 423.566	423.566 Coverage determinations.
42:3.0.1.1.10.13.11.6	SECTION 423.568	423.568 Standard timeframe and notice requirements for coverage determinations.
42:3.0.1.1.10.13.11.7	SECTION 423.570	423.570 Expediting certain coverage determinations.
42:3.0.1.1.10.13.11.8	SECTION 423.572	423.572 Timeframes and notice requirements for expedited coverage determinations.
42:3.0.1.1.10.13.11.9	SECTION 423.576	423.576 Effect of a coverage determination.
42:3.0.1.1.10.13.11.10	SECTION 423.578	423.578 Exceptions process.
42:3.0.1.1.10.13.11.11	SECTION 423.580	423.580 Right to a redetermination.
42:3.0.1.1.10.13.11.12	SECTION 423.582	423.582 Request for a standard redetermination.
42:3.0.1.1.10.13.11.13	SECTION 423.584	423.584 Expediting certain redeterminations.
42:3.0.1.1.10.13.11.14	SECTION 423.586	423.586 Opportunity to submit evidence.
42:3.0.1.1.10.13.11.15	SECTION 423.590	423.590 Timeframes and responsibility for making redeterminations.
42:3.0.1.1.10.13.11.16	SECTION 423.600	423.600 Reconsideration by an independent review entity (IRE).
42:3.0.1.1.10.13.11.17	SECTION 423.602	423.602 Notice of reconsideration determination by the independent review entity.
42:3.0.1.1.10.13.11.18	SECTION 423.604	423.604 Effect of a reconsideration determination.
42:3.0.1.1.10.13.11.19	SECTION 423.610-423.634	423.610-423.634 [Reserved]
42:3.0.1.1.10.13.11.20	SECTION 423.636	423.636 How a Part D plan sponsor must effectuate standard redeterminations, reconsiderations, or decisions.
42:3.0.1.1.10.13.11.21	SECTION 423.638	423.638 How a Part D plan sponsor must effectuate expedited redeterminations or reconsiderations.

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