---
kind: "range"
citation: "42 C.F.R. §§ 417.834–417.840"
title: "42"
from: "417.834"
to: "417.840"
count: 4
url: "https://uscodex.org/cfr/42/417.834..417.840"
---

# §417.834. Responsibility for establishing administrative review procedures.


The HCPP is responsible for establishing and maintaining the administrative review procedures that are specified in [§§ 417.830 through 417.840](/cfr/42/417.830..417.840.md).


# §417.836. Written description of administrative review procedures.


Each HCPP is responsible for ensuring that all Medicare enrollees are informed in writing of the administrative review procedures that are available to them.


# §417.838. Organization determinations.

- (a) **Actions that are organization determinations.** For purposes of [§§ 417.830 through 417.840](/cfr/42/417.830..417.840.md), an organization determination is a refusal to furnish or arrange for services, or reimburse the party for services provided to the beneficiary, on the grounds that the services are not covered by Medicare.
- (b) **Actions that are not organization determinations.** The following are not organization determinations for purposes of [§§ 417.830 through 417.840](/cfr/42/417.830..417.840.md):
  - (1) A determination regarding services that were furnished by the HCPP, either directly or under arrangement, for which the enrollee has no further obligation for payment.
  - (2) **A determination regarding services that are not covered under the HCPP's agreement with CMS.**

# §417.840. Administrative review procedures.


The HCPP must apply [§ 422.568](/cfr/42/422.568.md) through [§ 422.626](/cfr/42/422.626.md) of this chapter to—

- (a) Organization determinations and fast-track appeals that affect its Medicare enrollees; and
- (b) Reconsiderations, hearings, Medicare Appeals Council review, and judicial review of the organization determinations and fast-track appeals specified in [paragraph (a)](#a) of this section.