---
kind: "section"
citation: "42 C.F.R. § 423.582"
title: "42"
number: "423.582"
heading: "Request for a standard redetermination."
url: "https://uscodex.org/cfr/42/423.582"
---

# §423.582. Request for a standard redetermination.

- (a) **Method and place for filing a request.** An enrollee or an enrollee's prescribing physician or other prescriber (acting on behalf of the enrollee) must ask for a redetermination by making a written request with the Part D plan sponsor that made the coverage determination or the at-risk determination under a drug management program in accordance with [§ 423.153(f)](/cfr/42/423.153.md?p=f). The Part D plan sponsor may adopt a policy for accepting oral requests.
- (b) **Timeframe for filing a request.** Except as provided in [paragraph (c)](#c) of this section, a request for a redetermination must be filed within 60 calendar days after receipt of the written coverage determination notice or the at-risk determination under a drug management program in accordance with [§ 423.153(f)](/cfr/42/423.153.md?p=f).
  - (1) The date of receipt of the coverage determination or at-risk determination is presumed to be 5 calendar days after the date of the written coverage determination or at-risk determination, unless there is evidence to the contrary.
  - (2) For purposes of meeting the 60-calendar day filing deadline, the request is considered as filed on the date it is received by the Part D plan sponsor or delegated entity specified in the Part D plan sponsor's written coverage determination or at-risk determination.
- (c) **Extending the time for filing a request—**
  - (1) **General rule.** If an enrollee or prescribing physician or other prescriber acting on behalf of an enrollee shows good cause, the Part D plan sponsor may extend the timeframe for filing a request for redetermination.
  - (2) **How to request an extension of timeframe.** If the 60 calendar day period in which to file a request for a redetermination has expired, an enrollee or a prescribing physician or other prescriber acting on behalf of an enrollee may file a request for redetermination and extension of time frame with the Part D plan sponsor. The request for redetermination and to extend the timeframe must—
    - (i) Be in writing; and
    - (ii) **State why the request for redetermination was not filed on time.**
- (d) **Withdrawing a request.** The person who files a request for redetermination may withdraw it by filing a request with the Part D sponsor.
- (e) **Dismissing a request.** A Part D plan sponsor dismisses a redetermination request, either entirely or as to any stated issue, under any of the following circumstances:
  - (1) When the person or entity requesting a redetermination is not a proper party under [§ 423.580](/cfr/42/423.580.md).
  - (2) When the Part D plan sponsor determines the party failed to make out a valid request for redetermination that substantially complies with [paragraph (a)](#a) of this section.
  - (3) When the party fails to file the redetermination request within the proper filing time frame in accordance with [paragraph (b)](#b) of this section.
  - (4) When the enrollee or the enrollee's representative files a request for redetermination, but the enrollee dies while the request is pending, and both of the following criteria apply:
    - (i) **The enrollee's surviving spouse or estate has no remaining financial interest in the case.**
    - (ii) **The enrollee's representative, if any, does not wish to pursue the request for coverage.**
  - (5) When a party filing the redetermination request submits a timely request for withdrawal of the request for a redetermination with the Part D plan sponsor.
- (f) **Notice of dismissal.** The Part D plan sponsor must mail or otherwise transmit a written notice of the dismissal of the redetermination request to the parties. The notice must state all of the following:
  - (1) **The reason for the dismissal.**
  - (2) **The right to request that the Part D plan sponsor vacate the dismissal action.**
  - (3) **The right to request review of the dismissal by the independent entity.**
- (g) **Vacating a dismissal.** If good cause is established, a Part D sponsor may vacate its dismissal of a request for redetermination within 6 months from the date of the notice of dismissal.
- (h) **Effect of dismissal.** The dismissal of a request for redetermination is binding unless the enrollee or other party requests review by the IRE or the decision is vacated under [paragraph (g)](#g) of this section.

## Notes

### Amendments

[74 FR 1547, Jan. 12, 2009, as amended at 74 FR 65363, Dec. 9, 2009; 83 FR 16752, Apr. 16, 2018; 86 FR 6120, Jan. 19, 2021; 89 FR 30841, Apr. 23, 2024]

### Authority

Authority: 42 U.S.C. 1302, 1306, 1395w-101 through 1395w-152, and 1395hh.

### Source

Source: 70 FR 4525, Jan. 28, 2005, unless otherwise noted.

### Amendments

[74 FR 1547, Jan. 12, 2009, as amended at 74 FR 65363, Dec. 9, 2009; 83 FR 16752, Apr. 16, 2018; 86 FR 6120, Jan. 19, 2021; 89 FR 30841, Apr. 23, 2024]