42 CFR §422.504(i)(1)
May 23, 2020 4:33 pm(i) MA organization relationship with first tier, downstream, and related entities. (1) Notwithstanding any relationship(s) that the MA organization may... View more
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42 CFR §422.520(a)
April 29, 2020 5:48 am(a) Contract between CMS and the MA organization. (1) The contract between CMS and the MA organization must provide that... View more
42 CFR §422.566(d)
September 3, 2020 3:47 amIf the MA organization expects to issue a partially or fully adverse medical necessity (or any substantively equivalent term used... View more
42 CFR §422.568(b)(1)
October 3, 2019 6:38 am(b) Timeframes – (1) Requests for service or item. Except as provided in paragraph (b)(1)(i) of this section, when a... View more
42 CFR §422.568(e)
May 23, 2020 3:33 pmThe notice of any denial under paragraph (d) of this section must – (1) Use approved notice language in a... View more
42 CFR §422.590(g)(2)
May 5, 2020 9:22 am(g) Who must reconsider an adverse organization determination. (2) When the issue is the MA organization’s denial of coverage based... View more
42 USC § 1395ddd (f)(2)
May 23, 2020 3:38 pm(2) Limitation on recoupment (A) In general In the case of a provider of services or supplier that is determined... View more
45 CFR § 146.130 (a)
January 22, 2025 12:43 am(a) Hospital length of stay—(1) General rule. Except as provided in paragraph (a)(5) of this section, a group health plan,... View more
45 CFR §146.130(a)
April 29, 2020 5:48 am(a) Hospital length of stay – (1) General rule. Except as provided in paragraph (a)(5) of this section, a group... View more
45 CFR §164.530 (c)
May 23, 2020 4:26 pm(1) Standard: Safeguards. A covered entity must have in place appropriate administrative, technical, and physical safeguards to protect the privacy... View more