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Title 42

Displaying title 42, up to date as of 7/16/2026. Title 42 was last amended 7/01/2026.
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  1. Title 42 —Public Health
  2. Chapter IV —Centers for Medicare & Medicaid Services, Department of Health and Human Services
  3. Subchapter F —Quality Improvement Organizations
  4. Part 476 —Quality Improvement Organization Review
  5. Subpart C   View Full Text
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eCFR Content

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Title 42Public HealthPart / Section
Chapter IVCenters for Medicare & Medicaid Services, Department of Health and Human Services400 – 699
Subchapter FQuality Improvement Organizations475 – 481
Part 476Quality Improvement Organization Review476.1 – 476.170
Subpart CReview Responsibilities of Quality Improvement Organizations (QIOs)476.70 – 476.170
General Provisions476.70 – 476.82
§ 476.70Statutory bases and applicability.
§ 476.71QIO review requirements.
§ 476.73Notification of QIO designation and implementation of review.
§ 476.74General requirements for the assumption of review.
§ 476.76Cooperation with health care facilities.
§ 476.78Responsibilities of providers and practitioners.
§ 476.80Coordination with Medicare administrative contractors, fiscal intermediaries, and carriers
§ 476.82Continuation of functions not assumed by QIOs.
QIO Review Functions476.83 – 476.170
§ 476.83Initial denial determinations.
§ 476.84Changes as a result of DRG validation.
§ 476.85Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.
§ 476.86Correlation of Title XI functions with Title XVIII functions.
§ 476.88Examination of the operations and records of health care facilities and practitioners.
§ 476.90Lack of cooperation by a provider or practitioner.
§ 476.93Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.
§ 476.94Notice of QIO initial denial determination and changes as a result of a DRG validation.
§ 476.96Review period and reopening of initial denial determinations and changes as a result of DRG validations.
§ 476.98Reviewer qualifications and participation.
§ 476.100Use of norms and criteria.
§ 476.102Involvement of health care practitioners other than physicians.
§ 476.104Coordination of activities.
§ 476.110Use of immediate advocacy to resolve oral beneficiary complaints.
§ 476.120Submission of written beneficiary complaints.
§ 476.130Beneficiary complaint review procedures.
§ 476.140Beneficiary complaint reconsideration procedures.
§ 476.150Abandoned complaints and reopening rights.
§ 476.160General quality of care review procedures.
§ 476.170General quality of care reconsideration procedures.
eCFR Content