CMS Pub. 100-04, ch. 30, § 200.1

• Sections 1866(a)(1)(M),

• 1869(c)(3)(C)(iii)(III), and

• 1154(e) of the Act.

This process was implemented through a final rule with comment period, CMS-1655-F

(81 FR 56761, 57037 through 57052, August 22, 2016), effective October 1, 2016. The

resulting regulations are located at 42 CFR Part 405.1205 and 405.1206).

There is a parallel process for beneficiaries enrolled in Medicare health plans. (See 42

CFR 422.620 - 422.622 and §100.1 in the Parts C & D Enrollee Grievances,

Organization/Coverage Determinations, and Appeals Guidance.) Please see the Parts C &

D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance

for Medicare Advantage instructions.