{"abstract":"This final rule revises the procedures that the Department of Health and Human Services (HHS) follows at the Administrative Law Judge (ALJ) level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as well as appeals of Medicare beneficiary enrollment and entitlement determinations, and certain Medicare premium appeals. In addition, this final rule revises procedures that the Department of Health and Human Services follows at the Centers for Medicare & Medicaid Services (CMS) and the Medicare Appeals Council (Council) levels of appeal for certain matters affecting the ALJ level.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2017/01/17/2016-32058.html","cfr_references":[{"chapter":null,"citation_url":null,"part":401,"title":42},{"chapter":null,"citation_url":null,"part":405,"title":42},{"chapter":null,"citation_url":null,"part":422,"title":42},{"chapter":null,"citation_url":null,"part":423,"title":42},{"chapter":null,"citation_url":null,"part":478,"title":42}],"citation":"82 FR 4974","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"These regulations are effective on March 20, 2017.","disposition_notes":null,"docket_ids":["HHS-2016-79"],"dockets":[],"document_number":"2016-32058","effective_on":"2017-03-20","end_page":5140,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2017/01/17/2016-32058.xml","html_url":"https://www.federalregister.gov/documents/2017/01/17/2016-32058/medicare-program-changes-to-the-medicare-claims-and-entitlement-medicare-advantage-organization","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2016-32058?publication_date=2017-01-17","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2017-01-17/2016-32058/mods.xml","not_received_for_publication":null,"page_length":167,"page_views":{"count":14967,"last_updated":"2026-07-26 02:15:03 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2017-01-17/pdf/2016-32058.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2016-32058.pdf?1484315130","publication_date":"2017-01-17","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2017/01/17/2016-32058.txt","regulation_id_number_info":{"0991-AC02":{"issue":"201604","html_url":"https://www.federalregister.gov/regulations/0991-AC02/medicare-program-changes-to-the-medicare-claims-and-entitlement-medicare-advantage-organization-dete","title":"Medicare Program; Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201604&RIN=0991-AC02&operation=OPERATION_EXPORT_XML","priority_category":"Other Significant"}},"regulation_id_numbers":["0991-AC02"],"regulations_dot_gov_info":{"supporting_documents":[],"comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS_FRDOC_0001","supporting_documents_count":0,"docket_id":"CMS_FRDOC_0001","regulation_id_number":null,"title":"Recently Posted CMS Rules and Notices.","checked_regulationsdotgov_at":"2017-02-06T06:00:16Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":4974,"subtype":null,"title":"Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures","toc_doc":"Changes to Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures","toc_subject":"Medicare Program:","topics":["Administrative practice and procedure","Claims","Emergency medical services","Freedom of information","Health care","Health facilities","Health maintenance organizations (HMO)","Health professions","Kidney diseases","Medical devices","Medicare","Peer Review Organizations (PRO)","Penalties","Privacy","Reporting and recordkeeping requirements","Rural areas","X-rays"],"type":"Rule","volume":82}