Subpart M—Grievances, Organization Determinations and Appeals
- §422.560 Basis and scope.
- §422.561 Definitions.
- §422.562 General provisions.
- §422.564 Grievance procedures.
- §422.566 Organization determinations.
- §422.568 Standard timeframes and notice requirements for organization determinations.
- §422.570 Expediting certain organization determinations.
- §422.572 Timeframes and notice requirements for expedited organization determinations.
- §422.574 Parties to the organization determination.
- §422.576 Effect of an organization determination.
- §422.578 Right to a reconsideration.
- §422.580 Reconsideration defined.
- §422.582 Request for a standard reconsideration.
- §422.584 Expediting certain reconsiderations.
- §422.586 Opportunity to submit evidence.
- §422.590 Timeframes and responsibility for reconsiderations.
- §422.592 Reconsideration by an independent entity.
- §422.594 Notice of reconsidered determination by the independent entity.
- §422.596 Effect of a reconsidered determination.
- §422.600 Right to a hearing.
- §422.602 Request for an ALJ hearing.
- §422.608 Medicare Appeals Council (Council) review.
- §422.612 Judicial review.
- §422.616 Reopening and revising determinations and decisions.
- §422.618 How an MA organization must effectuate standard reconsidered determinations or decisions.
- §422.619 How an MA organization must effectuate expedited reconsidered determinations.
- §422.620 Notifying enrollees of hospital discharge appeal rights.
- §422.622 Requesting immediate QIO review of the decision to discharge from the inpatient hospital.
- §422.624 Notifying enrollees of termination of provider services.
- §422.626 Fast-track appeals of service terminations to independent review entities (IREs).
- Requirements Applicable to Certain Integrated Dual Eligible Special Needs Plans (§§ 422.629 - 422.634)