Grievance and Appeal System

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Medical Assistance Programs
  6. Managed Care
  7. Grievance and Appeal System

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Section
438.400

Statutory basis, definitions, and applicability.

Section
438.402

General requirements.

Section
438.404

Timely and adequate notice of adverse benefit determination.

Section
438.406

Handling of grievances and appeals.

Section
438.408

Resolution and notification: Grievances and appeals.

Section
438.410

Expedited resolution of appeals.

Section
438.414

Information about the grievance and appeal system to providers and subcontractors.

Section
438.416

Recordkeeping requirements.

Section
438.420

Continuation of benefits while the MCO, PIHP, or PAHP appeal and the State fair hearing are pending.

Section
438.424

Effectuation of reversed appeal resolutions.