United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2017_register executive 2017-01-14 article Part II Rules and Regulations D09002ee1c7f2f0a0 D09002ee1c7f2f188 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency This final rule revises the procedures that the Department of Health and Human Services (HHS) follows at the Administrative Law Judge (ALJ) level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as well as appeals of Medicare beneficiary enrollment and entitlement determinations, and certain Medicare premium appeals. In addition, this final rule revises procedures that the Department of Health and Human Services follows at the Centers for Medicare & Medicaid Services (CMS) and the Medicare Appeals Council (Council) levels of appeal for certain matters affecting the ALJ level. 82 FR 4974 https://www.govinfo.gov/app/details/FR-2017-01-17/2016-32058 2016-32058 fr17ja17-12 RIN 0991-AC02 4150-46-P HHS-2016-79 https://www.govinfo.gov/app/details/FR-2017-01-17/2016-32058 https://www.govinfo.gov/content/pkg/FR-2017-01-17/html/2016-32058.htm https://www.govinfo.gov/content/pkg/FR-2017-01-17/pdf/2016-32058.pdf Claims Freedom of Information Health Facilities Medicare Privacy Administrative Practice and Procedure Health Professions Kidney Diseases Medical Devices Reporting and Recordkeeping Requirements Rural Areas X-Rays Health Maintenance Organizations (Hmo) Penalties Emergency Medical Services Health Professionals Health Care Peer Review Organizations (Pro) 167 p. 4974 5140 82 FR 4974 Title 42 Part 401 42 CFR Part 401 Title 42 Part 405 42 CFR Part 405 Title 42 Part 422 42 CFR Part 422 Title 42 Part 423 42 CFR Part 423 Title 42 Part 478 42 CFR Part 478 RIN 0991-AC02 Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures; Federal Register Vol. 82, Issue RULE 2016-32058 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2017-03-20 HHS-2016-79 4150-46-P 2016-32058 Final rule.

This final rule revises the procedures that the Department of Health and Human Services (HHS) follows at the Administrative Law Judge (ALJ) level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as well as appeals of Medicare beneficiary enrollment and entitlement determinations, and certain Medicare premium appeals. In addition, this final rule revises procedures that the Department of Health and Human Services follows at the Centers for Medicare & Medicaid Services (CMS) and the Medicare Appeals Council (Council) levels of appeal for certain matters affecting the ALJ level.

These regulations are effective on March 20, 2017. Joella Roland, (410) 786-7638 (for issues related to CMS appeals policies and reopening policies). Claims Freedom of Information Health Facilities Medicare Privacy Administrative Practice and Procedure Health Professions Kidney Diseases Medical Devices Reporting and Recordkeeping Requirements Rural Areas X-Rays Health Maintenance Organizations (Hmo) Penalties Emergency Medical Services Health Professionals Health Care Peer Review Organizations (Pro) Medicare Program: Changes to Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures , OIRA_submission@omb.eop.gov http://aasis.omha.hhs.gov http://oig.hhs.gov/oei/reports/oei-04-97-00160.pdf https://dab.E-File.hhs.gov/mod https://www.cms.gov/medicare/cms-forms/cms-forms/cms-forms-list.html https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS1696.pdf https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup/ https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html https://www.ssa.gov/legislation/medicare/medicare_appeal_transfer.pdf www.hhs.gov www.hhs.gov/dab www.hhs.gov/omha www.medicare.gov/claims-and-appeals/file-an-appeal/appeals.html Vol. 82, no. 10 Office of the Federal Register, National Archives and Records Administration 2017-01-17 continuing daily deposited born digital 569 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2017-01-17 P0b002ee19356c77d 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr17ja17 https://www.govinfo.gov/app/details/FR-2017-01-17 https://www.govinfo.gov/content/pkg/FR-2017-01-17/pdf/FR-2017-01-17.pdf https://www.govinfo.gov/content/pkg/FR-2017-01-17/xml/FR-2017-01-17.xml fdlp 4769 5329 DGPO 2017-01-14 2024-06-01 FR-2017-01-17 machine generated eng FR FR-2017-01-17 82 10