StacksVerified U.S. regulatory reference

42 CFR §423.558

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
  1. (a)This subpart sets forth the requirements relating to the following:
    1. (1)Part D plan sponsors with respect to grievances, coverage determinations, and redeterminations.
    2. (2)Part D IRE with respect to reconsiderations.
    3. (3)Part D enrollees' rights with respect to grievances, coverage determinations, redeterminations, and reconsiderations.
    4. (4)Review of at-risk determinations made under a drug management program in accordance with § 423.153(f).
  2. (b)The requirements regarding reopenings, ALJ hearings and ALJ and attorney adjudicator decisions, Council review, and judicial review are set forth in subpart U of this chapter.