Revisions to Chapter 13, “Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals Applicable to Medicare Advantage Plans, Cost Plans, and Health Care Prepayment Plans (HCPPs),” (collectively referred to as Medicare Health Plans)
This transmittal includes the following changes: Addition of definition for ‘Medicare Health Plan,’ clarifying language to the definition of ‘Grievance’ and ‘Representative’; clarifications to procedures for handling a grievance; clarifications regarding written notification by Medicare health plan of its own decision; clarifications regarding representatives filing appeals for enrollees; clarifications regarding expedited review of coverage terminations in certain provider settings; updates to amounts in controversy; clarifications regarding a new final rule implemented on July 1, 2007, updates regarding collection and reporting cycle dates for data; and updates to several chapter Appendices.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 21, 2007
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