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Federal Law

Title 45-Subtitle A-Subchapter B-Part 156-Subpart C. Qualified Health Plan Minimum Certification Standards

08/15/2020 45 CFR 156.230

Network adequacy standards

Continuity of Care Post-Contract-Fed. Exchange Reg., Directories-Fed. Exchange Reg., Med. Adv.-Med. Nec. Decisions-Deadlines, Network Adequacy-Fed. Exchange Reg.

Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

08/15/2020 42 CFR 422.572

Timeframes and notice requirements for expedited organization determinations

Med. Adv.-Med. Nec. Decisions-Deadlines

Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

12/17/2021 42 CFR 422.570

Expediting certain organization determinations

Anti-retaliation-Med. Adv., Med. Adv.-Med. Nec. Decisions-Deadlines

Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

12/17/2021 42 CFR 422.568

Standard timeframes and notice requirements for organization determinations

Med. Adv.-Med. Nec. Decisions-Deadlines

Federal Law

Title 42-Chapter 7-Subchapter XVIII-Part C. Medicare+Choice Program

08/14/2020 42 USC Section 1395w-22

Benefits and beneficiary protections

Anti-gag clause-Med. Adv., Directories-Med. Adv., Liability-insurer shifting to physician-Med. Adv., Med. Adv.-Med. Nec. Appeals-Deadlines, Med. Adv.-Med. Nec. Decisions-Deadlines, Network Adequacy-Med. Adv., Prohibited financial incentives-Med. Adv., Risk-Physicians Taking-Med. Adv.

Ama Policy

Private Health Insurance Formulary Transparency H-125.979

12/30/2021

ERISA-Med. Nec. Decisions-Deadlines, Med. Adv.-Med. Nec. Decisions-Deadlines, State Medical Necessity Decisions-Deadlines