C.F.R. » Title 42 » 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

42 C.F.R. § 423.580

Right to a redetermination

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

An enrollee who has received a coverage determination (including one that is reopened and revised as described in § 423.1978) or an at-risk determination under a drug management program in accordance with § 423.153(f) may request that it be redetermined under the procedures described in § 423.582, which address requests for a standard redetermination. The prescribing physician or other prescriber (acting on behalf of an enrollee), upon providing notice to the enrollee, may request a standard redetermination under the procedures described in § 423.582. An enrollee or an enrollee's prescribing physician or other prescriber (acting on behalf of an enrollee) may request an expedited redetermination as specified in § 423.584.

[83 FR 16752, Apr. 16, 2018]
Notes of Decisions
Cited in 1 case (1 in the last 5 years), 2021–2021 · leading case: Akebia Therapeutics, Inc. v. Azar (D. Mass. 2021).
Sort: Relevance Newest Treatment
Akebia Therapeutics, Inc. v. Azar (D. Mass. 2021). “See 42 C.F.R. §§ 423.580 , 423.586. Third, a beneficiary, an appointed representative, or a prescribing physician may seek additional review from an independent contractor.”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.