SUBPART M—Grievances, Organization Determinations and Appeals (§422.560 to §422.626)
- 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 (MAC) 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).