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Grievances, Coverage Determinations, Redeterminations, and Reconsiderations
Law
CFR 42
Public Health
Centers for Medicare & Medicaid Services, Department of Health and Human Services
Medicare Program
Voluntary Medicare Prescription Drug Benefit
Grievances, Coverage Determinations, Redeterminations, and Reconsiderations
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Section
423.558
Scope.
Section
423.560
Definitions.
Section
423.562
General provisions.
Section
423.564
Grievance procedures.
Section
423.566
Coverage determinations.
Section
423.568
Standard timeframe and notice requirements for coverage determinations.
Section
423.570
Expediting certain coverage determinations.
Section
423.572
Timeframes and notice requirements for expedited coverage determinations.
Section
423.576
Effect of a coverage determination.
Section
423.578
Exceptions process.
Section
423.580
Right to a redetermination.
Section
423.582
Request for a standard redetermination.
Section
423.584
Expediting certain redeterminations.
Section
423.586
Opportunity to submit evidence.
Section
423.590
Timeframes and responsibility for making redeterminations.
Section
423.600
Reconsideration by an independent review entity (IRE).
Section
423.602
Notice of reconsideration determination by the independent review entity.
Section
423.604
Effect of a reconsideration determination.
Sections
423.610-423.634
§§ 423.610-423.634 [Reserved]
Section
423.636
How a Part D plan sponsor must effectuate standard redeterminations, reconsiderations, or decisions.
Section
423.638
How a Part D plan sponsor must effectuate expedited redeterminations or reconsiderations.