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42 U.S.C. 1302, 1306, 1395w-101 through 1395w-152, and 1395hh.
70 FR 4525, Jan. 28, 2005, unless otherwise noted.
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(a) This subpart sets forth the requirements relating to the following:
(1) Part D plan sponsors with respect to grievances, coverage determinations, and redeterminations.
(2) Part D IRE with respect to reconsiderations.
(3) Part D enrollees' rights with respect to grievances, coverage determinations, redeterminations, and reconsiderations.
(4) Review of at-risk determinations made under a drug management program in accordance with § 423.153(f).
(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.
[74 FR 65363, Dec. 9, 2009, as amended at 82 FR 5125, Jan. 17, 2017; 83 FR 16750, Apr. 16, 2018]