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U.S. Code Regulations Constitution Journal Apps
  1. Regulations
    All Titles
  2. title 42
    Public Health
  3. chapter IV-i2
    CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)
  4. part 438
    PART 438—MANAGED CARE
  5. subpart F
    Subpart F—Grievance and Appeal System

Subpart F. Subpart F—Grievance and Appeal System

  • § 438.400 - Statutory basis, definitions, and applicability.
  • § 438.402 - General requirements.
  • § 438.404 - Timely and adequate notice of adverse benefit determination.
  • § 438.406 - Handling of grievances and appeals.
  • § 438.408 - Resolution and notification: Grievances and appeals.
  • § 438.410 - Expedited resolution of appeals.
  • § 438.414 - Information about the grievance and appeal system to providers and subcontractors.
  • § 438.416 - Recordkeeping requirements.
  • § 438.420 - Continuation of benefits while the MCO, PIHP, or PAHP appeal and the State fair hearing are pending.
  • § 438.424 - Effectuation of reversed appeal resolutions.
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