GroundRules
42 CFR 423.586: Opportunity to submit evidence.
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 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
- Subpart M—Grievances, Coverage Determinations, Redeterminations, and Reconsiderations
The Part D plan sponsor must provide the enrollee or the prescribing physician or other prescriber, as appropriate, with a reasonable opportunity to present evidence and allegations of fact or law, related to the issue in dispute, in person as well as in writing. In the case of an expedited redetermination, the opportunity to present evidence is limited by the short timeframe for making a decision. Therefore, the Part D plan sponsor must inform the enrollee or the prescribing physician or other prescriber of the conditions for submitting the evidence.
Collected 2026-08-27T02:26:11Z. Source file · JSON