42 CFR Subpart M
Grievances, Organization Determinations and Appeals
June 11, 2020
§
422.580
Reconsideration defined
§
422.560
Basis and scope
§
422.560
[Amendment] Basis and scope
§
422.561
Definitions
§
422.562
General provisions
§
422.564
Grievance procedures
§
422.566
Organization determinations
§
422.566
[Amendment] 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
§
422.582
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)
§
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