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- 42 CFR 423.2310 · Condition for coverage of drugs under Part D.
- 42 CFR 423.2315 · Medicare Coverage Gap Discount Program Agreement.
- 42 CFR 423.2320 · Payment processes for Part D sponsors.
- 42 CFR 423.2325 · Provision of applicable discounts.
- 42 CFR 423.2330 · Manufacturer discount payment audit and dispute resolution.
- 42 CFR 423.2335 · Beneficiary dispute resolution.
- 42 CFR 423.2340 · Compliance monitoring and civil money penalties.
- 42 CFR 423.2345 · Termination of Coverage Gap Discount Program Agreement.
- 42 CFR 423.2400 · Basis and scope.
- 42 CFR 423.2401 · Definitions.
- 42 CFR 423.2410 · General requirements.
- 42 CFR 423.2420 · Calculation of medical loss ratio.
- 42 CFR 423.2430 · Activities that improve health care quality.
- 42 CFR 423.2440 · Credibility adjustment.
- 42 CFR 423.2450 · [Reserved]
- 42 CFR 423.2460 · Reporting requirements.
- 42 CFR 423.2470 · Remittance to CMS if the applicable MLR requirement is not met.
- 42 CFR 423.2480 · MLR review and non-compliance.
- 42 CFR 423.2490 · Release of Part D MLR data.
- 42 CFR 423.2500 · Basis and scope.
- 42 CFR 423.2504 · LI NET eligibility and enrollment.
- 42 CFR 423.2508 · LI NET benefits and beneficiary protections.
- 42 CFR 423.2512 · LI NET sponsor requirements.
- 42 CFR 423.2516 · Selection of LI NET sponsor and contracting provisions.
- 42 CFR 423.2518 · Intermediate sanctions for the LI NET sponsor.
- 42 CFR 423.2520 · Non-renewal or termination of appointment.
- 42 CFR 423.2524 · Bidding and payments to LI NET sponsor.
- 42 CFR 423.2536 · Waiver of Part D program requirements.
- 42 CFR 423.2600 · Payment appeals.
- 42 CFR 423.2605 · Request for reconsideration.
- 42 CFR 423.2610 · Hearing official review.
- 42 CFR 423.2615 · Review by the Administrator.
- 42 CFR 423.2700 · Basis and scope.
- 42 CFR 423.2704 · Definitions.
- 42 CFR 423.2708 · Conditions for coverage of drugs under Part D.
- 42 CFR 423.2712 · Applicable discounts.
- 42 CFR 423.2716 · Phase-in of applicable discount for certain manufacturers.
- 42 CFR 423.2720 · Determination of phase-in eligibility.
- 42 CFR 423.2724 · Effect of manufacturer acquisition on phase-in eligibility.
- 42 CFR 423.2728 · Recalculation of phase-in eligibility determination.
- 42 CFR 423.2732 · Use of third party administrator.
- 42 CFR 423.2736 · Requirement for point-of-sale discounts.
- 42 CFR 423.2740 · Negative invoice payment process for Part D sponsors.
- 42 CFR 423.2744 · Prospective payments to Part D sponsors.
- 42 CFR 423.2748 · Requirement to use the Health Plan Management System.
- 42 CFR 423.2752 · Manufacturer Discount Program agreement.
- 42 CFR 423.2756 · Manufacturer requirements.
- 42 CFR 423.2760 · Audits.
- 42 CFR 423.2764 · Dispute resolution.
- 42 CFR 423.2768 · Civil money penalties.
- 42 CFR 424.1 · Basis and scope.
- 42 CFR 424.3 · Definitions.
- 42 CFR 424.5 · Basic conditions.
- 42 CFR 424.7 · General limitations.
- 42 CFR 424.10 · Purpose and scope.
- 42 CFR 424.11 · General procedures.
- 42 CFR 424.13 · Requirements for inpatient services of hospitals other than inpatient psychiatric facilities.
- 42 CFR 424.14 · Requirements for inpatient services of inpatient psychiatric facilities.
- 42 CFR 424.15 · Requirements for inpatient CAH services.
- 42 CFR 424.16 · Timing of certification for individual admitted to a hospital before entitlement to Medicare benefits.
- 42 CFR 424.20 · Requirements for posthospital SNF care.
- 42 CFR 424.22 · Requirements for home health services.
- 42 CFR 424.24 · Requirements for medical and other health services furnished by providers under Medicare Part B.
- 42 CFR 424.27 · Requirements for comprehensive outpatient rehabilitation facility (CORF) services.
- 42 CFR 424.30 · Scope.
- 42 CFR 424.32 · Basic requirements for all claims.
- 42 CFR 424.33 · Additional requirements: Claims for services of providers and claims by suppliers and nonparticipating hospitals.
- 42 CFR 424.34 · Additional requirements: Beneficiary's claim for direct payment.
- 42 CFR 424.36 · Signature requirements.
- 42 CFR 424.37 · Evidence of authority to sign on behalf of the beneficiary.
- 42 CFR 424.40 · Request for payment effective for more than one claim.
- 42 CFR 424.44 · Time limits for filing claims.
- 42 CFR 424.50 · Scope.
- 42 CFR 424.51 · Payment to the provider.
- 42 CFR 424.52 · Payment to a nonparticipating hospital.
- 42 CFR 424.53 · Payment to the beneficiary.
- 42 CFR 424.54 · Payment to the beneficiary's legal guardian or representative payee.
- 42 CFR 424.55 · Payment to the supplier.
- 42 CFR 424.56 · Payment to a beneficiary and to a supplier.
- 42 CFR 424.57 · Special payment rules for items furnished by DMEPOS suppliers and issuance of DMEPOS supplier billing privileges.
- 42 CFR 424.58 · Accreditation.
- 42 CFR 424.60 · Scope.
- 42 CFR 424.62 · Payment after beneficiary's death: Bill has been paid.
- 42 CFR 424.64 · Payment after beneficiary's death: Bill has not been paid.
- 42 CFR 424.66 · Payment to entities that provide coverage complementary to Medicare Part B.
- 42 CFR 424.67 · Enrollment requirements for opioid treatment programs (OTP).
- 42 CFR 424.68 · Enrollment requirements for home infusion therapy suppliers.
- 42 CFR 424.70 · Basis and scope.
- 42 CFR 424.71 · Definitions.
- 42 CFR 424.73 · Prohibition of assignment of claims by providers.
- 42 CFR 424.74 · Termination of provider agreement.
- 42 CFR 424.80 · Prohibition of reassignment of claims by suppliers.
- 42 CFR 424.82 · Revocation of right to receive assigned benefits.
- 42 CFR 424.83 · Hearings on revocation of right to receive assigned benefits.
- 42 CFR 424.84 · Final determination on revocation of right to receive assigned benefits.
- 42 CFR 424.86 · Prohibition of assignment of claims by beneficiaries.
- 42 CFR 424.90 · Court ordered assignments: Conditions and limitations.
- 42 CFR 424.100 · Scope.
- 42 CFR 424.101 · Definitions.
- 42 CFR 424.102 · Situations that do not constitute an emergency.