Federal Laws

Find out what rights you and your patients have under current federal statutes and regulations, such as the Employee Retirement Income Security Act and the Medicare Advantage program.

Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart C. Benefits and Beneficiary Protections

08/14/2020 42 CFR 422.116

Network adequacy

Network Adequacy-Med. Adv.
Federal Law

Title 29-Chapter 18-Subchapter I-Subtitle B-Part 5. Administration and Enforcement

08/14/2020 29 USC ยง 1144

Other Laws

Preemption-ERISA
Federal Law

TITLE 29. Labor-Subtitle B-Chapter XXV-Subchapter G-Part 2560-Rules And Regulations For Administration And Enforcement-

04/25/2019 29 CFR 2560.503-1

Claims Procedure

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, Preemption-ERISA
Federal Law

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

08/15/2020 45 CFR 156.235

Essential community providers

Network Adequacy-Fed. Exchange Reg.
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart C. Benefits and Beneficiary Protections

08/14/2020 42 CFR 422.114

Access to services under an MA private fee-for-service plan

Network Adequacy-Med. Adv.
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 45-Subtitle A-Subchapter B-Part 147. Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets

08/15/2020 45 CFR 147.136

Internal claims and appeals and external review processes

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines
Federal Law

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

08/15/2020 42 CFR 422.619

How an MA organization must effectuate expedited reconsidered determinations

Med. Adv.-Med. Nec. Appeals-Deadlines
Federal Law

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

04/30/2019 42 CFR 422.618

How an MA organization must effectuate standard reconsidered determinations or decisions.

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

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

08/15/2020 42 CFR 422.590

Timeframes and responsibility for reconsiderations

Med. Adv.-Med. Nec. Appeals-Deadlines