42 C.F.R. § 423.580
Right to a redetermination.
Cite as 42 C.F.R. § 423.580 (2026)
An enrollee who has received a coverage determination (including one that is reopened and revised as described in § 423.1978) or an at-risk determination under a drug management program in accordance with § 423.153(f) may request that it be redetermined under the procedures described in § 423.582, which address requests for a standard redetermination. The prescribing physician or other prescriber (acting on behalf of an enrollee), upon providing notice to the enrollee, may request a standard redetermination under the procedures described in § 423.582. An enrollee or an enrollee's prescribing physician or other prescriber (acting on behalf of an enrollee) may request an expedited redetermination as specified in § 423.584.
[83 FR 16752, Apr. 16, 2018]
- Cross-references to the CFR
- 423.153423.1978423.582423.582.423.584.