42 CFR Subpart M - Grievances, Organization Determinations and Appeals

  1. § 422.560 Basis and scope.
  2. § 422.561 Definitions.
  3. § 422.562 General provisions.
  4. § 422.564 Grievance procedures.
  5. § 422.566 Organization determinations.
  6. § 422.568 Standard timeframes and notice requirements for organization determinations.
  7. § 422.570 Expediting certain organization determinations.
  8. § 422.572 Timeframes and notice requirements for expedited organization determinations.
  9. § 422.574 Parties to the organization determination.
  10. § 422.576 Effect of an organization determination.
  11. § 422.578 Right to a reconsideration.
  12. § 422.580 Reconsideration defined.
  13. § 422.582 Request for a standard reconsideration.
  14. § 422.584 Expediting certain reconsiderations.
  15. § 422.586 Opportunity to submit evidence.
  16. § 422.590 Timeframes and responsibility for reconsiderations.
  17. § 422.592 Reconsideration by an independent entity.
  18. § 422.594 Notice of reconsidered determination by the independent entity.
  19. § 422.596 Effect of a reconsidered determination.
  20. § 422.600 Right to a hearing.
  21. § 422.602 Request for an ALJ hearing.
  22. § 422.608 Medicare Appeals Council (Council) review.
  23. § 422.612 Judicial review.
  24. § 422.616 Reopening and revising determinations and decisions.
  25. § 422.618 How an MA organization must effectuate standard reconsidered determinations or decisions.
  26. § 422.619 How an MA organization must effectuate expedited reconsidered determinations.
  27. § 422.620 Notifying enrollees of hospital discharge appeal rights.
  28. § 422.622 Requesting immediate QIO review of the decision to discharge from the inpatient hospital.
  29. § 422.624 Notifying enrollees of termination of provider services.
  30. § 422.626 Fast-track appeals of service terminations to independent review entities (IREs).
  31. § 422.629 xxx
  32. § 422.630 xxx
  33. § 422.631 xxx
  34. § 422.632 xxx
  35. § 422.633 xxx
  36. § 422.634 xxx
Link to an amendment published at 84 FR 15835, April 16, 2019.
Source:
63 FR 35107, June 26, 1998, unless otherwise noted.