Subpart M - GRIEVANCES, ORGANIZATION DETERMINATIONS AND APPEALS
- Section 422.560 - Basis and scope
- Section 422.561 - Definitions
- Section 422.562 - General provisions
- Section 422.564 - Grievance procedures
- Section 422.566 - Organization determinations
- Section 422.568 - [Effective 4/8/2024] Standard timeframes and notice requirements for organization determinations
- Section 422.568 - [Effective until 4/8/2024] Standard timeframes and notice requirements for organization determinations
- Section 422.570 - [Effective 4/8/2024] Standard timeframes and notice requirements for organization determinations
- Section 422.570 - [Effective until 4/8/2024] Expediting certain organization determinations
- Section 422.572 - Timeframes and notice requirements for expedited organization determinations
- Section 422.574 - Parties to the organization determination
- Section 422.576 - Effect of an organization determination
- Section 422.578 - Right to a reconsideration
- Section 422.580 - Reconsideration defined
- Section 422.582 - Request for a standard reconsideration
- Section 422.584 - Expediting certain reconsiderations
- Section 422.586 - Opportunity to submit evidence
- Section 422.590 - Timeframes and responsibility for reconsiderations
- Section 422.592 - Reconsideration by an independent entity
- Section 422.594 - Notice of reconsidered determination by the independent entity
- Section 422.596 - Effect of a reconsidered determination
- Section 422.600 - Right to a hearing
- Section 422.602 - Request for an ALJ hearing
- Section 422.608 - Medicare Appeals Council (Council) review
- Section 422.612 - Judicial review
- Section 422.616 - Reopening and revising determinations and decisions
- Section 422.618 - How an MA organization must effectuate standard reconsidered determinations or decisions
- Section 422.619 - How an MA organization must effectuate expedited reconsidered determinations
- Section 422.620 - Notifying enrollees of hospital discharge appeal rights
- Section 422.622 - Requesting immediate QIO review of the decision to discharge from the inpatient hospital
- Section 422.624 - Notifying enrollees of termination of provider services
- Section 422.626 - Fast-track appeals of service terminations to independent review entities (IREs)
- REQUIREMENTS APPLICABLE TO CERTAIN INTEGRATED DUAL ELIGIBLE SPECIAL NEEDS PLANS (§§ 422.629 — 422.634)