{"data":{"id":"us/42-cfr-423.558","jurisdiction":"us","citation":"42 CFR 423.558","heading":"Scope.","body":"(a) This subpart sets forth the requirements relating to the following:\n(1) Part D plan sponsors with respect to grievances, coverage determinations, and redeterminations.\n(2) Part D IRE with respect to reconsiderations.\n(3) Part D enrollees' rights with respect to grievances, coverage determinations, redeterminations, and reconsiderations.\n(4) Review of at-risk determinations made under a drug management program in accordance with § 423.153(f).\n(b) The requirements regarding reopenings, ALJ hearings and ALJ and attorney adjudicator decisions, Council review, and judicial review are set forth in subpart U of this chapter.","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 M—Grievances, Coverage Determinations, Redeterminations, and Reconsiderations"],"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":"eb80c0274097361f835620e75eb259451c731b0430654d504b23816b0169390c","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-423.553","next":"us/42-cfr-423.560"},"notice":"GroundRules: Original legal text. Not legal advice."}