title: Medicare program; improvement to the Medicare+Choice appeal and grievance procedures. Final rule with comment period.
abstract: 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.
mesh_terms: 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