---
kind: "section"
citation: "45 C.F.R. § 152.26"
title: "45"
number: "152.26"
heading: "Appeals procedures."
url: "https://uscodex.org/cfr/45/152.26"
---

# §152.26. Appeals procedures.

- (a) **General.** A PCIP shall establish and maintain procedures for individuals to appeal eligibility and coverage determinations.
- (b) **Minimum requirements.** The appeals procedure must, at a minimum, provide:
  - (1) 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.
  - (2) 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.
  - (3) An enrollee with the right to a timely reconsideration of a redetermination made under [paragraph (b)(2)](#b-2) of this section by an entity independent of the PCIP.

## Notes

### 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.