Federal (United States) · Regulations
Subpart M — Grievances, Organization Determinations and Appeals
36 sections
36 sections
- 42 C.F.R. § 422.560Basis and scope.
- 42 C.F.R. § 422.561Definitions.
- 42 C.F.R. § 422.562General provisions.
- 42 C.F.R. § 422.564Grievance procedures.
- 42 C.F.R. § 422.566Organization determinations.
- 42 C.F.R. § 422.568Standard timeframes and notice requirements for organization determinations.
- 42 C.F.R. § 422.570Expediting certain organization determinations.
- 42 C.F.R. § 422.572Timeframes and notice requirements for expedited organization determinations.
- 42 C.F.R. § 422.574Parties to the organization determination.
- 42 C.F.R. § 422.576Effect of an organization determination.
- 42 C.F.R. § 422.578Right to a reconsideration.
- 42 C.F.R. § 422.580Reconsideration defined.
- 42 C.F.R. § 422.582Request for a standard reconsideration.
- 42 C.F.R. § 422.584Expediting certain reconsiderations.
- 42 C.F.R. § 422.586Opportunity to submit evidence.
- 42 C.F.R. § 422.590Timeframes and responsibility for reconsiderations.
- 42 C.F.R. § 422.592Reconsideration by an independent entity.
- 42 C.F.R. § 422.594Notice of reconsidered determination by the independent entity.
- 42 C.F.R. § 422.596Effect of a reconsidered determination.
- 42 C.F.R. § 422.600Right to a hearing.
- 42 C.F.R. § 422.602Request for an ALJ hearing.
- 42 C.F.R. § 422.608Medicare Appeals Council (Council) review.
- 42 C.F.R. § 422.612Judicial review.
- 42 C.F.R. § 422.616Reopening and revising determinations and decisions.
- 42 C.F.R. § 422.618How an MA organization must effectuate standard reconsidered determinations or decisions.
- 42 C.F.R. § 422.619How an MA organization must effectuate expedited reconsidered determinations.
- 42 C.F.R. § 422.620Notifying enrollees of hospital discharge appeal rights.
- 42 C.F.R. § 422.622Requesting immediate QIO review of the decision to discharge from the inpatient hospital.
- 42 C.F.R. § 422.624Notifying enrollees of termination of provider services.
- 42 C.F.R. § 422.626Fast-track appeals of service terminations to independent review entities (IREs).
- 42 C.F.R. § 422.629General requirements for applicable integrated plans.
- 42 C.F.R. § 422.630Integrated grievances.
- 42 C.F.R. § 422.631Integrated organization determinations.
- 42 C.F.R. § 422.632Continuation of benefits while the applicable integrated plan reconsideration is pending.
- 42 C.F.R. § 422.633Integrated reconsiderations.
- 42 C.F.R. § 422.634Effect.