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…
This revision includes the following changes:
• The chapter title is changed from Medicare+Choice Beneficiary Grievances,
Organization Determinations, and Appeals, to 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.)
• The term Medicare+Choice (M+C) is replaced by Medicare Advantage (MA);
• The term Medicare Advantage Organization (MAO) along with cost plans and
HCPPs are collectively described as a Medicare health plan;
• The term Departmental Appeals Board (DAB) is replaced by Medicare Appeals
Council (MAC);
• The Railroad Retirement Board (RRB) and the Social Security Administration
(SSA) are eliminated as places for filing appeal requests;
• A number of clarifications have been made throughout the document that does not
affect the meaning of the affected section(s);
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: March 03, 2006
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.