Code of Federal Regulations > Title 42 > Chapter IV > Part 422 > Subpart M - Subpart M—Grievances, Organization Determinations and Appeals

U.S. Code of Federal Regulations

Regulations most recently checked for updates: Oct 06, 2025

REQUIREMENTS APPLICABLE TO CERTAIN INTEGRATED DUAL ELIGIBLE SPECIAL NEEDS PLANS

§ 422.629 - General requirements for applicable integrated plans.

§ 422.630 - Integrated grievances.

§ 422.631 - Integrated organization determinations.

§ 422.632 - Continuation of benefits while the applicable integrated plan reconsideration is pending.

§ 422.633 - Integrated reconsiderations.

§ 422.634 - Effect.

§ 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 (Council) 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).