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Grievances, Organization Determinations and Appeals | Midpage
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Code of Federal Regulations
Title 42
Chapter IV
Subchapter B
Part 422
Subpart M
Grievances, Organization Determinations and Appeals
422.560
Basis and scope.
422.561
Definitions.
422.562
General provisions.
422.564
Grievance procedures.
422.566
Organization determinations.
422.568
Standard timeframes and notice requirements for organization determinations.
422.570
Expediting certain organization determinations.
422.572
Timeframes and notice requirements for expedited organization determinations.
422.574
Parties to the organization determination.
422.576
Effect of an organization determination.
422.578
Right to a reconsideration.
422.580
Reconsideration defined.
422.582
Request for a standard reconsideration.
422.584
Expediting certain reconsiderations.
422.586
Opportunity to submit evidence.
422.590
Timeframes and responsibility for reconsiderations.
422.592
Reconsideration by an independent entity.
422.594
Notice of reconsidered determination by the independent entity.
422.596
Effect of a reconsidered determination.
422.600
Right to a hearing.
422.602
Request for an ALJ hearing.
422.608
Medicare Appeals Council (Council) review.
422.612
Judicial review.
422.616
Reopening and revising determinations and decisions.
422.618
How an MA organization must effectuate standard reconsidered determinations or decisions.
422.619
How an MA organization must effectuate expedited reconsidered determinations.
422.620
Notifying enrollees of hospital discharge appeal rights.
422.622
Requesting immediate QIO review of the decision to discharge from the inpatient hospital.
422.624
Notifying enrollees of termination of provider services.
422.626
Fast-track appeals of service terminations to independent review entities (IREs).
ECFR5ebb4ff974abdb5
Requirements Applicable to Certain Integrated Dual Eligible Special Needs Plans