Medicare program; improvement to the Medicare+Choice appeal and grievance procedures. Final rule with comment period.
This final rule with comment period responds to comments on the January 24, 2001, proposed rule regarding improvements to the Medicare+Choice (M+C) appeal and grievance procedures. It establishes new notice and appeal procedures for enrollees when an M+C organization decides to terminate coverage of provider services. The January 24, 2001 proposed rule was published as a required element of an agreement entered into between the parties in Grijalva v. Shalala, civ. 93-711 (U.S.D.C. Az.), to settle a class action lawsuit. This rule also specifies a Medicare-participating hospital's responsibility for issuing discharge or termination notices under both the original Medicare and M+C programs, amends the Medicare provider agreement regulations with regard to beneficiary notification requirements, and amends M+C enrollee grievance procedures.
D006801:Humans; D007342:Insurance Benefits / Q000331:legislation & jurisprudence; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence*; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D016365:Liability, Legal; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D020398:Medicare Part C / Q000331:legislation & jurisprudence*; D010351:Patient Discharge; D017060:Patient Satisfaction / Q000331:legislation & jurisprudence*; D014481:United States