GroundRules
42 CFR 422.594: Notice of reconsidered determination by the independent entity.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER B—MEDICARE PROGRAM
- PART 422—MEDICARE ADVANTAGE PROGRAM
- Subpart M—Grievances, Organization Determinations and Appeals
(a) Responsibility for the notice. When the independent entity makes the reconsidered determination, it is responsible for mailing a notice of its reconsidered determination to the parties and for sending a copy to CMS.
(b) Content of the notice. The notice must—
(1) State the specific reasons for the entity's decisions in understandable language;
(2) If the reconsidered determination is adverse (that is, does not completely reverse the MA organization's adverse organization determination), inform the parties of their right to an ALJ hearing if the amount in controversy meets the requirements of § 422.600;
(3) Describe the procedures that a party must follow to obtain an ALJ hearing; and
(4) Comply with any other requirements specified by CMS.
Collected 2026-08-27T02:26:11Z. Source file · JSON