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Federal Law

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

11/25/2024 42 CFR Section 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

11/15/2024 42 CFR Section 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

11/15/2024 42 CFR Section 422.568

Standard timeframes and notice requirements for organization determinations

Med. Adv.-Med. Nec. Decisions-Deadlines, Prompt Payment Deadlines
Federal Law

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

11/21/2024 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