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- Code of Federal Regulations
- C.F.R. Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER B—MEDICARE PROGRAM
- PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
- Subpart M—Grievances, Coverage Determinations, Redeterminations, and Reconsiderations
42 C.F.R. § 423.558
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Source: 74 FR 65363, Dec. 9, 2009, as amended at 82 FR 5125, Jan. 17, 2017; 83 FR 16750, Apr. 16, 2018
Table of Contents
Subpart M—Grievances, Coverage Determinations, Redeterminations, and Reconsiderations
- §423.558 Scope.
- §423.560 Definitions.
- §423.562 General provisions.
- §423.564 Grievance procedures.
- §423.566 Coverage determinations.
- §423.568 Standard timeframe and notice requirements for coverage determinations.
- §423.570 Expediting certain coverage determinations.
- §423.572 Timeframes and notice requirements for expedited coverage determinations.
- §423.576 Effect of a coverage determination.
- §423.578 Exceptions process.
- §423.580 Right to a redetermination.
- §423.582 Request for a standard redetermination.
- §423.584 Expediting certain redeterminations.
- §423.586 Opportunity to submit evidence.
- §423.590 Timeframes and responsibility for making redeterminations.
- §423.600 Reconsideration by an independent review entity (IRE).
- §423.602 Notice of reconsideration determination by the independent review entity.
- §423.604 Effect of a reconsideration determination.
- §423.610-423.634 [Reserved]
- §423.636 How a Part D plan sponsor must effectuate standard redeterminations, reconsiderations, or decisions.
- §423.638 How a Part D plan sponsor must effectuate expedited redeterminations or reconsiderations.