---
kind: "section"
citation: "42 C.F.R. § 438.410"
title: "42"
number: "438.410"
heading: "Expedited resolution of appeals."
url: "https://uscodex.org/cfr/42/438.410"
---

# §438.410. Expedited resolution of appeals.

- (a) **General rule.** Each MCO, PIHP, and PAHP must establish and maintain an expedited review process for appeals, when the MCO, PIHP, or PAHP determines (for a request from the enrollee) or the provider indicates (in making the request on the enrollee's behalf or supporting the enrollee's request) that taking the time for a standard resolution could seriously jeopardize the enrollee's life, physical or mental health, or ability to attain, maintain, or regain maximum function.
- (b) **Punitive action.** The MCO, PIHP, or PAHP must ensure that punitive action is not taken against a provider who requests an expedited resolution or supports an enrollee's appeal.
- (c) **Action following denial of a request for expedited resolution.** If the MCO, PIHP, or PAHP denies a request for expedited resolution of an appeal, it must—
  - (1) Transfer the appeal to the timeframe for standard resolution in accordance with [§ 438.408(b)(2)](/cfr/42/438.408.md?p=b-2).
  - (2) Follow the requirements in [§ 438.408(c)(2)](/cfr/42/438.408.md?p=c-2).

## Notes

### Source

Source: 81 FR 27853, May 6, 2016, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 67 FR 41095, June 14, 2002, unless otherwise noted.