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us/regulation/42/423/subpart-M — Subpart M - Grievances, Coverage Determinations, Redeterminations, and Reconsiderations · Axiom
Axiom
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US Federal
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Regulations
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Title 42
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Part 423
Subpart M - Grievances, Coverage Determinations, Redeterminations, and Reconsiderations
20 sections
558
Scope
560
Definitions
562
General provisions
564
Grievance procedures
566
Coverage determinations
568
Standard timeframe and notice requirements for coverage determinations
570
Expediting certain coverage determinations
572
Timeframes and notice requirements for expedited coverage determinations
576
Effect of a coverage determination
578
Exceptions process
580
Right to a redetermination
582
Request for a standard redetermination
584
Expediting certain redeterminations
586
Opportunity to submit evidence
590
Timeframes and responsibility for making redeterminations
600
Reconsideration by an independent review entity (IRE)
602
Notice of reconsideration determination by the independent review entity
604
Effect of a reconsideration determination
636
How a Part D plan sponsor must effectuate standard redeterminations, reconsiderations, or decisions
638
How a Part D plan sponsor must effectuate expedited redeterminations or reconsiderations
