§152.26. Appeals procedures.
45 C.F.R. § 152.26
General. A PCIP shall establish and maintain procedures for individuals to appeal eligibility and coverage determinations.
Minimum requirements. The appeals procedure must, at a minimum, provide:
A potential enrollee with the right to a timely redetermination by the PCIP or its designee of a determination regarding PCIP eligibility, including a determination of whether the individual is a citizen or national of the United States, or is lawfully present in the United States.
An enrollee with the right to a timely redetermination by the PCIP or its designee of a determination regarding the coverage of a service or the amount paid by the PCIP for a service.
An enrollee with the right to a timely reconsideration of a redetermination made under paragraph (b)(2) of this section by an entity independent of the PCIP.
Notes, amendments, and revision history
Authority
Authority: Sec. 1101 of the Patient Protection and Affordable Care Act (Pub. L. 111-148).
Source
Source: 75 FR 45029, July 30, 2010, unless otherwise noted.