Subpart M - GRIEVANCES, COVERAGE DETERMINATIONS, REDETERMINATIONS, AND RECONSIDERATIONS
- Section 423.558 - Scope
- Section 423.560 - Definitions
- Section 423.562 - [Effective 6/3/2024] General provisions
- Section 423.562 - [Effective until 6/3/2024] General provisions
- Section 423.564 - Grievance procedures
- Section 423.566 - Coverage determinations
- Section 423.568 - Standard timeframe and notice requirements for coverage determinations
- Section 423.570 - Expediting certain coverage determinations
- Section 423.572 - Timeframes and notice requirements for expedited coverage determinations
- Section 423.576 - Effect of a coverage determination
- Section 423.578 - [Effective 6/3/2024] Exceptions process
- Section 423.578 - [Effective until 6/3/2024] Exceptions process
- Section 423.580 - Right to a redetermination
- Section 423.582 - [Effective 6/3/2024] Request for a standard redetermination
- Section 423.582 - [Effective until 6/3/2024] Request for a standard redetermination
- Section 423.584 - [Effective 6/3/2024] Expediting certain redeterminations
- Section 423.584 - [Effective until 6/3/2024] Expediting certain redeterminations
- Section 423.586 - Opportunity to submit evidence
- Section 423.590 - Timeframes and responsibility for making redeterminations
- Section 423.600 - [Effective 6/3/2024] Reconsideration by an independent review entity (IRE)
- Section 423.600 - [Effective until 6/3/2024] Reconsideration by an independent review entity (IRE)
- Section 423.602 - Notice of reconsideration determination by the independent review entity
- Section 423.604 - Effect of a reconsideration determination
- Section 423.610-423.634 - Reserved
- Section 423.636 - How a Part D plan sponsor must effectuate standard redeterminations, reconsiderations, or decisions
- Section 423.638 - How a Part D plan sponsor must effectuate expedited redeterminations or reconsiderations