Grievance and Appeal System | Midpage

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Code of Federal Regulations

Subpart F

Grievance and Appeal System

438.400Statutory basis, definitions, and applicability.438.402General requirements.438.404Timely and adequate notice of adverse benefit determination.438.406Handling of grievances and appeals.438.408Resolution and notification: Grievances and appeals.438.410Expedited resolution of appeals.438.414Information about the grievance and appeal system to providers and subcontractors.438.416Recordkeeping requirements.438.420Continuation of benefits while the MCO, PIHP, or PAHP appeal and the State fair hearing are pending.438.424Effectuation of reversed appeal resolutions.