{"data":{"id":"us/42-cfr-423.2536","jurisdiction":"us","citation":"42 CFR 423.2536","heading":"Waiver of Part D program requirements.","body":"CMS waives the following Part D program requirements for the LI NET program:\n(a) General information. Paragraphs (1) and (3)(B) of section 1860D-4(a) of the Act (relating to dissemination of general information; availability of information on changes in formulary through the internet).\n(b) Formularies. Subparagraphs (A) and (B) of section 1860D-4(b)(3) of the Act (relating to requirements on development and application of formularies; formulary development) and formulary requirements in §§ 423.120(b) and 423.128(e)(5) and (6).\n(c) Medicare Prescription Payment Plan. Section 423.137.\n(d) Cost control and quality improvement requirements. Provisions under subpart D of this part, including requirements about medication therapy management, are waived except for the provisions in § 423.2508(c)(1) through (5).\n(1) Section 423.153(b) and (c) for dispensing and point-of-sale safety edits;\n(2) Section 423.154 for appropriate dispensing of prescription drugs in long-term care facilities;\n(3) Sections 423.159 and 423.160 for electronic prescribing, excepting the requirements pertaining to formulary standards in § 423.160(b)(5);\n(4) Section 423.162 for QIO activities; and\n(5) Section 423.165 for compliance deemed on the basis of accreditation.\n(e) Out-of-network access. Section 423.124 Special rules for out-of-network access to Part D drugs at out-of-network pharmacies, except for § 423.124(a)(2), which applies to LI NET.\n(f) Medicare contract determinations and appeals. Subpart N, except for the provisions that apply to LI NET in § 423.2520(d).\n(g) Risk-sharing arrangements. Section 423.336(a), (b), and (d).\n(h) Certification of accuracy of data for price comparison. Section 423.505(k)(6).\n(i) Part D communication requirements. Portions of subpart V of this part related to Part D communication requirements that are inapplicable to LI NET, including:\n(1) Section 423.2265(b)(4), (5), (11), (13), and (16);\n(2) Section 423.2265(c);\n(3) Section 423.2266(a);\n(4) Section 423.2267(e)(3) through (5), (9) through (12), (14) through (17), (25), (29), (33), and (45) through (51); and\n(5) Section 423.2274.\n(j) Medicare Coverage Gap Discount Program. Subpart W of this part.\n(k) Requirements for a minimum medical loss ratio. Subpart X of this part.\n(l) Recovery audit contractor Part C appeals process. Subpart Z of this part.\n(m) Provision of specific information. Section 423.128(d)(1)(i)(A).","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER B—MEDICARE PROGRAM","PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT","Subpart Y—Transitional Coverage and Retroactive Medicare Part D Coverage for Certain Low-Income Beneficiaries Through the Limited Income Newly Eligible Transition (LI NET) Program"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"9da35b545e637a3271d3166933c53e87d323746bae795045443496521a36b7bf","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-423.2524","next":"us/42-cfr-423.2600"},"notice":"GroundRules: Original legal text. Not legal advice."}