Original Medicare (Fee-for-service) Appeals

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menu-item--collapsed"> <a href="/medicare/medicaid-coordination/center-program-integrity/resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/674936">Resources</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/medicaid-coordination/about/qualified-medicare-beneficiary-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/184631">Qualified Medicare beneficiary program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/medicaid-coordination/center-program-integrity/spotlight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/674941">Spotlight</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/medicaid-coordination/center-program-integrity/events" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/674946">Events</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicaid-chip/medicare-coordination/financial-alignment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178246">Financial alignment initiative</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicaid-chip/medicare-coordination/avoidable-hospitalizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181236">Initiative to reduce avoidable hospitalizations </a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/medicaid-coordination/center-program-integrity/reports-guidance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/674951">Reports & Guidance</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/medicaid-coordination/pace" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175651">Program of All-Inclusive Care for the Elderly (PACE)</a> </li> <li class="menu-item 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</div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Quality</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/value-based-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/188566">Value-based programs</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/quality/initiatives/hospital-quality-initiative/person-family-engagement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/182996">Person & Family Engagement</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/quality-improvement-organizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169871">Quality improvement organizations</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/nursing-home-improvement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171236">Nursing home quality improvement</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/inpatient-rehabilitation-facility" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175616">Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/home-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170541">Home Health Quality Reporting Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/end-stage-renal-disease-esrd-quality-incentive-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176126">ESRD Quality Incentive Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/meaningful-measures-initiative/cms-quality-strategy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178276">CMS National Quality Strategy</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/hospice" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175556">Hospice Quality Reporting Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/long-term-care-hospital" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175511">Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/appropriate-use-criteria-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180421">Appropriate Use Criteria Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/measures" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172001">Quality measures</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/clinical-laboratory-improvement-amendments" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172651">Clinical Laboratory Improvement Amendments (CLIA)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/advantage-quality-improvement-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177561">Medicare Advantage quality improvement program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/physician-compare-initiative" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175221">Physician compare initiative</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/initiatives" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169636">Quality initiatives</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/part-c-d-performance-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171491">Part C and D Performance Data</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/quality/snf-quality-reporting-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180061"> Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Health & safety standards</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/quality-safety-oversight-general-information" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169631">Quality, safety & oversight - General information</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/accreditation-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171481">Accreditation programs</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/civil-monetary-penalties" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/182431">Civil monetary penalties</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/quality-safety-oversight-emergency-preparedness" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172346">Quality, safety & oversight - Emergency preparedness</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/state-survey-agencies" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171271">State survey agencies</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/certification-compliance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171241">Certification & compliance</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/enforcement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169811">Enforcement</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/guidance-for-laws-regulations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170071">Quality, safety & oversight - Guidance for laws & regulations</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/promising-practices-project" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172211">Promising practices project</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/education-division" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/173371">Quality, safety & oversight - Education division (QSED)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/conditions-coverage-participation" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172616">Conditions for coverage & participation</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Employers & plan sponsors</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/employers-plan-sponsors/creditable-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171701">Creditable coverage</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2"> <span class="menu-item-element" aria-current="false">IC-Placeholder-1</span> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Audits & Compliance</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/audits-compliance/part-a-cost-report" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185256">Part A cost report audit</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/audits-compliance/part-c-d" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175921">Part C/Part D compliance & audits</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Forms & notices</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/medicare/forms-notices/cms-forms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170166">CMS forms</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/forms-notices/cms-forms-list" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174306">CMS forms list</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/forms-notices/beneficiary-notices-initiative" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170686">Beneficiary Notices Initiative (BNI)</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Health & drug plans</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-drug-plans/plan-payment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171981">Plan payment</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/plan-payment-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175081">Plan payment data</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/medical-loss-ratio" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180161">Medical loss ratio</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/coverage-gap-discount-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175906">Coverage Gap Discount Program</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-drug-plans/managed-care-marketing" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170611">Managed care marketing</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/medicare-advantage-application" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170651">Medicare Advantage application</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-drug-plans/medigap" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170466">Medigap (Medicare supplement health insurance)</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/medical-savings-account" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172066">Medical Savings Account (MSA)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-drug-plans/private-fee-for-service-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170301">Private Fee-for-Service Plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/enrollment-renewal/health-plans/prepayment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170521">Health Care Prepayment Plans (HCPPs)</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/enrollment-renewal/health-plans/cost" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170656">Cost plans</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/enrollment-renewal/special-needs-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171676">Special needs plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-drug-plans/network-adequacy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171301">Network adequacy</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Coordination of benefits & recovery</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/overview" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177001">Overview</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/mandatory-insurer-reporting-group-health-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176856">Mandatory Insurer Reporting for Group Health Plans (GHP)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/mandatory-insurer-reporting" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176951">Mandatory insurer reporting (NGHP)</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/workers-comp-set-aside-arrangements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176641">Workers' comp Medicare set aside arrangements</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/attorney-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177026">Attorney services</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/beneficiary-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177036">Beneficiary services</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/coba-trading-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176761">COBA Trading Partners</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/employer-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170361">Employer services</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/insurer-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170846">Insurer services</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/prescription-drug-assistance-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176791">Prescription drug assistance programs</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/coordination-benefits-recovery/provider-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170406">Provider services</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Settlements</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/medicare/settlements/jimmo" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193381">Jimmo Settlement</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/settlements/ryan" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193486">Ryan Settlement</a> </li> </ul> </div> </div> </li> </ul> </div> </li> <li class="menu-item menu-item--l1 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Medicaid/CHIP</span> <div class="subnav-wrapper--1 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-main ds-u-lg-display--none">Back to main menu</span> <h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2> </div> <ul class="menu"> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">What is Medicaid?</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="https://www.medicaid.gov" class="menu-item-element" aria-current="false">Visit Medicaid.gov</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.medicaid.gov/about-us/beneficiary-resources/index.html#statemenu" class="menu-item-element" aria-current="false">View Medicaid maps</a> </li> <li class="menu-item menu-item--l3"> <a href="http://www.medicaid.gov/chip/index.html" class="menu-item-element" aria-current="false">Visit CHIP.gov</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Medicare-Medicaid Coordination</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/medicaid-chip/medicare-coordination/integrated-care-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174926">Integrated care resources</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicaid-chip/medicare-coordination/avoidable-hospitalizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181236">Initiative to reduce avoidable hospitalizations</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicaid-chip/medicare-coordination/financial-alignment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178246">Financial alignment initiative</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicaid-chip/medicare-coordination/integrity-institute" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1315141">Medicaid Integrity Institute</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2"> <span class="menu-item-element" aria-current="false">RG-Placeholder-1</span> </li> <li class="menu-item menu-item--l2"> <span class="menu-item-element" aria-current="false">IC-Placeholder-2</span> </li> </ul> </div> </li> <li class="menu-item menu-item--l1 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Marketplace & Private Insurance</span> <div class="subnav-wrapper--1 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-main ds-u-lg-display--none">Back to main menu</span> <h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2> </div> <ul class="menu"> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">About the Marketplace</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/about/oversight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191061">Marketplace oversight</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/about/affordable-care-act" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191416">Affordable Care Act</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/about/overview-exchanges" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190921">Overview of the exchanges</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/about/exchange-coverage-maps" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193086">Exchange coverage maps</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/about/medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/179351">Medicare and the Marketplace</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Private Health Insurance</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/patient-bill-of-rights" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192591">Patient’s Bill of Rights</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/medical-loss-ratio" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190956">Medical loss ratio</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/annual-limits" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191976">Annual limits</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/review-insurance-rates" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192716">Review of insurance rates</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/market-rating-reforms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191816">Market rating</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/self-funded-non-federal-governmental-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191111">Self-funded, non-federal governmental plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/grandfathered-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191456">Grandfathered plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/health-reimbursement-arrangements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193216">Health Reimbursement Arrangements</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/coverage-young-adults" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190931">Coverage for young adults</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/student-health-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190946">Student health plans</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/mental-health-parity-addiction-equity" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192601">Mental health parity and addiction equity</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/prevention" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191071">Prevention</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/consumer-protections-enforcement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192701">Consumer protections & enforcement</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/private-health-insurance/pre-existing-condition-plan" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191056">Pre-existing condition insurance plan</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/glossary/qualifying-health-coverage" class="menu-item-element" aria-current="false">Qualifying Health Coverage (QHC)</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2"> <span class="menu-item-element" aria-current="false">RG-Placeholder-2</span> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">In-person assisters</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/in-person-assisters/information-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2078851">Information for Partners</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/outreach-education" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073436">Assister outreach & education</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/applications-forms-notices" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073441">Applications, forms, & notices</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/programs-procedures" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073446">Assister programs & procedures</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/technical-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073231">Assister technical resources</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/in-person-assisters/training-webinars" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073451">Assister training & webinars</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Agents & Brokers</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192876">Resources for Agent & Brokers</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/registration-training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1290426">Registration & training</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/open-enrollment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193226">Open enrollment</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/direct-enrollment-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1550226">Direct enrollment partners</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/general-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185021">General resources</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.youtube.com/playlist?list=PLaV7m2-zFKpgUK9AqdbnOdW69-WwodvRj" class="menu-item-element" aria-current="false">Video Learning Center</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.agentbrokerfaq.cms.gov/s/" class="menu-item-element" aria-current="false">Agent & Broker FAQ</a> </li> <li class="menu-item menu-item--l3"> <a href="/files/document/agent/broker-help-desks.pdf" class="menu-item-element" aria-current="false" data-drupal-link-system-path="media/112386">Marketplace help desk & call centers</a> </li> <li class="menu-item menu-item--l3"> <a href="https://data.healthcare.gov/ffm_ab_registration_lists" class="menu-item-element" aria-current="false">Registration Completion List</a> </li> <li class="menu-item menu-item--l3"> <a href="https://data.healthcare.gov/ab-registration-tracker/" class="menu-item-element" aria-current="false">Marketplace Registration Tracker</a> </li> <li class="menu-item menu-item--l3"> <a href="https://data.healthcare.gov/ab-suspension-and-termination-list" class="menu-item-element" aria-current="false">AB Suspension & Termination List</a> </li> <li class="menu-item menu-item--l3"> <a href="https://localhelp.healthcare.gov/" class="menu-item-element" aria-current="false">Find local help</a> </li> <li class="menu-item menu-item--l3"> <a href="https://data.healthcare.gov/issuer-partner-lookup" class="menu-item-element" aria-current="false">Issuer and direct enrollment partner directory</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/help-on-demand" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193196">Help on demand</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/agents-brokers/shop-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193096">SHOP Resources</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Health Plans & Issuers</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/health-plans-issuers/qualified-health-plan-certification" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191371">Qualified health plan certification </a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/health-plans-issuers/summary-benefits-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191461">Summary of benefits & coverage</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/health-plans-issuers/insurance-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192101">Insurance programs</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/health-plans-issuers/premium-stabilization-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191326">Premium stabilization programs</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/health-plans-issuers/insurance-market-reforms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191421">Health insurance market reforms</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/health-plans-issuers/minimum-essential-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192891">Minimum essential coverage</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace-private-insurance/health-plans-issuers/pbm-drug-pricing-review" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2088761">Drug pricing & rebate review</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Employers & sponsors</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/small-businesses/other-coverage" class="menu-item-element" aria-current="false">Coverage</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/shop-marketplace-overview" class="menu-item-element" aria-current="false">Regulation & guidance</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/qualify-for-shop-marketplace" class="menu-item-element" aria-current="false">Small business tax credit & premium assistance</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/appeal-a-shop-decision" class="menu-item-element" aria-current="false">Appeals</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/employers-sponsors/small-business-health-options-program-shop" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192901">Small Business Health Options Program (SHOP)</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/employers-sponsors/early-retiree-reinsurance-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191651">Early retiree reinsurance program</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/employer-initiatives" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192916">Employer initiatives</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">States</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/state-marketplace-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190916">Planning & establishing a Marketplace</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/territory-cooperative-agreements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190926">Territory cooperative agreements</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/early-innovator-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191691">Early innovator program</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/state-flexibility-stabilize-market" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193246">State flexibility to stabilize the Market </a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/states/creating-competitive-marketplace" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192231">Exchange establishment grants</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.healthcare.gov/coverage/pre-existing-conditions" class="menu-item-element" aria-current="false">Pre-existing condition insurance plan</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Resources</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/about-us" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192721">About Us</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/marketplace/resources/data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191741">Data resources</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/forms-reports-other" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190966">Forms, reports, & other resources</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/letters" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191646">Letters</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/regulations-guidance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191366">Regulations & Guidance</a> </li> <li class="menu-item menu-item--l3"> <a href="/marketplace/resources/training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191466">Training resources</a> </li> </ul> </div> </div> </li> </ul> </div> </li> <li class="menu-item menu-item--l1 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Priorities</span> <div class="subnav-wrapper--1 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-main ds-u-lg-display--none">Back to main menu</span> <h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2> </div> <ul class="menu"> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Innovation Center</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/priorities/innovation/overview" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2090631">Overview</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation/about" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2074091">About</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation/key-concepts" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072461">Key Concepts</a> </li> <li class="menu-item menu-item--l3"> <a href="/priorities/innovation-center/model-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2087691">Model Data</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation-center/value-based-care-spotlight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2082926">Value-Based Care Spotlight</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation/models" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072436">Innovation Models</a> </li> <li class="menu-item menu-item--l3"> <a href="/priorities/innovation/where-innovation-happening" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072451">Where Innovation is Happening</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/innovation/evaluation-research-reports" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072446">Evaluations & Research Reports</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Health Equity</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/health-equity/c2c" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1974361">Coverage to Care</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/health-equity/minority-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1620916">Minority health</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/health-equity/c2c/es" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072591">Cobertura de atención</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/health-equity/grants-awards" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1612961">Grants & awards</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Recent Legislation</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/inflation-reduction-act-and-medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1621896">Inflation Reduction Act and Medicare</a> </li> <li class="menu-item menu-item--l3"> <a href="/nosurprises" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1573261">No Surprises Act</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Key Initiatives</span> <div class="subnav-wrapper--2 ds-u-display--none"> <div class="subnav-header"> <span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span> <h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3> </div> <div class="menu-wrapper"> <ul class="menu"> <li class="menu-item menu-item--l3"> <a href="/priorities/key-initiatives/opioids" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1620416">Opioids</a> </li> <li 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href="/medicare/appeals-grievances/original-medicare-appeals/medicare-appeals-good-cause-late-filing" aria-current="false" data-drupal-link-system-path="node/1621811">Medicare Appeals Good Cause for Late Filing</a> </li> </ul></li> </ul></li> </ul></li> </ul> </nav> </div> </div> <div class="ds-l-col--12 ds-l-md-col--8 ds-l-lg-col--9"> <div id="block-cms-evo-content" class="block block-system block-system-main-block"> <div class="content"> <span class="create-date"> </span> <div class="node node--type-section-page node--view-mode-full clearfix"> <div class="node__content clearfix"> <div class="subsite_body"> <div class="layout--constrained section--bg-style-none section--bg-color-none layout layout--onecol-section"> <div class="ds-l-container"> <div class="ds-l-row"> <div class="layout__column ds-l-col--12 cms-global-center"> <div class="block block-layout-builder block-field-blocknodesection-pagetitle"> <div class="content"> <span class="create-date"> </span> <span class="field field--name-title field--type-string field--label-visually_hidden alternate-page-title ds-u-margin-bottom--0 ds-u-font-size--3xl ds-u-font-weight--semibold">Original Medicare (Fee-for-service) Appeals</span> </div> </div> <div class="block block-layout-builder block-field-blocknodesection-pagebody"> <div class="content"> <span class="create-date"> </span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><div class="rxbodyfield"><h2><strong>What’s New</strong></h2><p><strong>October 11, 2024</strong></p><p>Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that implements a court order in the case, Alexander v. Azar (Alexander v. Azar, 613 F. Supp. 3d 559 (D. Conn. 2020), aff’d sub nom., Barrows v. Becerra, 24 F.4th 116 (2d Cir. 2022). This final rule establishes appeals processes for certain people with Original Medicare who are initially admitted to a hospital as an inpatient but subsequently reclassified by the hospital as an outpatient receiving observation services during their hospital stay and meet other eligibility criteria.  <br>We are targeting January 1, 2025 for implementation of the retrospective appeals procedures. We are targeting February 14, 2025 for implementation of the prospective appeals procedures. We will post updates here and on the appeals section of Medicare.gov  with detailed information when these appeals can be filed by eligible beneficiaries.</p><p>Information about this rule is available at this link to <a href="/files/document/medicare-appeal-rights-certain-changes-patient-status-final-rule-fact-sheet.pdf" data-entity-type="media" data-entity-uuid="6aa969d9-ddd9-4cd4-9a24-17aedfe902fa" data-entity-substitution="canonical" title="Medicare Appeal Rights for Certain Changes in Patient Status FINAL RULE Fact Sheet">Medicare Appeal Rights for Certain Changes in Patient Status FINAL RULE Fact Sheet (PDF)</a><br>The final rule can be viewed or downloaded from the Federal Register at: <a href="https://www.federalregister.gov/public-inspection/2024-23195/medicare-program-appeal-rights-for-certain-changes-in-patient-status">https://www.federalregister.gov/public-inspection/2024-23195/medicare-program-appeal-rights-for-certain-changes-in-patient-status</a></p><p><strong>December 21, 2023 - Proposed Rule Update</strong></p><p>Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would implement an order from the Federal district court for the District of Connecticut in Alexander v. Azar that would establish appeals processes for certain people with Original Medicare who are initially admitted to a hospital as an inpatient but subsequently reclassified by the hospital as an outpatient receiving observation services during their hospital stay and meet other eligibility criteria.  </p><p>Detailed information is available in this link to <a href="https://edit.cms.gov/files/document/medicare-appeal-rights-certain-changes-patient-status-factsheet.pdf" title="Medicare Appeal Rights for Certain Changes in Patient Status Proposed Rule Fact Sheet">Medicare Appeal Rights for Certain Changes in Patient Status Proposed Rule Fact Sheet</a></p><p>The proposed rule can be viewed or downloaded from the Federal Register at: <a href="https://www.federalregister.gov/documents/2023/12/27/2023-28152/medicare-program-appeal-rights-for-certain-changes-in-patient-status">https://www.federalregister.gov/documents/2023/12/27/2023-28152/medicare-program-appeal-rights-for-certain-changes-in-patient-status</a> </p><p><span lang="EN"><strong>July 28, 2022 – Updated Notice Regarding Court Decision Concerning Certain Appeal Rights for Medicare Beneficiaries</strong></span></p><p>A federal district court issued a Memorandum of Decision dated March 24, 2020 (Alexander v. Azar, Case No. 3:11-cv-1703-MPS, -- F. Supp. 3d --, 2020 WL 1430089 (D. Conn. Mar. 24, 2020)), and entered a Judgment dated March 26, 2020 in a class action seeking certain appeal rights for Medicare beneficiaries who receive observation services as outpatients. Additional information on this decision is available in the Downloads section below. On January 25, 2022, the United States Court of Appeals for the Second Circuit affirmed the judgment of the district court and its grant of injunctive relief.  The district court’s decision is now final.</p><p>The appeal process for this new type of beneficiary appeal is still under development and is not currently available. More information will be posted here when it is available. Information for Medicare beneficiaries regarding the court’s decision and appeal process has been posted to Medicare.gov <a href="https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal" title="https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal">here</a>, under the Appeals in Original Medicare tab. </p><h2><strong>Overview - Standard Appeals Process</strong></h2><p>Once an initial claim determination is made, any party to that initial determination, such as beneficiaries, providers, and suppliers – or their respective appointed representatives – has the right to appeal the Medicare coverage and payment decision. For more information on who is a party, see <a href="https://www.ecfr.gov/current/title-42/section-405.906">42 CFR 405.906</a>.</p><p><a href="https://www.ssa.gov/OP_Home/ssact/title18/1869.htm#b1">Section 1869</a> of the Social Security Act and <a href="https://www.ecfr.gov/current/title-42/part-405/subpart-I">42 CFR part 405 subpart I</a> contain the procedures for conducting appeals of claims in Original Medicare (Medicare Part A and Part B).</p><p>There are five levels in the Medicare Part A and Part B appeals process. The levels are:</p><ol><li><strong>First Level of Appeal:</strong>        Redetermination by a Medicare Administrative Contractor (MAC)</li><li><strong>Second Level of Appeal:</strong>   Reconsideration by a Qualified Independent Contractor (QIC)</li><li><strong>Third Level of Appeal:</strong>       Decision by the Office of Medicare Hearings and Appeals (OMHA)</li><li><strong>Fourth Level of Appeal:</strong>     Review by the Medicare Appeals Council</li><li><strong>Fifth Level of Appeal:   </strong>     Judicial Review in Federal District Court</li></ol><p>For detailed information about each level of appeal, use the navigation bar on the left side of this page. A downloadable brochure from the Medicare Learning Network (MLN) designed as a quick reference to the claims appeals process for providers, physicians, and other suppliers can be found in the "Related Links" section below.  To see a diagram (flowchart) of the original Medicare (fee-for-service) standard and expedited appeals process, go to the "Downloads" section below.</p><h2><strong>Appointment of Representative</strong></h2><p>A party may appoint any individual, including an attorney, to act as his or her representative during the processing of a claim(s) and /or any claim appeals.  A representative may be appointed at any time during the appeals process.  </p><p>There are 2 ways that a party can appoint a representative:</p><ol><li>Fill out the Appointment of Representative Form (CMS-1696; a link to this form can be found in the "Related Links" section below); or</li><li>Create a written notice containing all of the elements listed in <a href="https://www.ecfr.gov/cgi-bin/text-idx?SID=25fdeea6994ec206b89645d10ce4376c&mc=true&node=se42.2.405_1910&rgn=div8">42 CFR 405.910</a>.  </li></ol><p>The appointment of representative is valid for one year from the date it contains the signatures of both the party and the appointed representative.  A valid appointment of representative may be used multiple times to initiate new appeals on behalf of the party, unless the party provides a written statement of revocation of the representative’s authority. The appointment remains valid for any subsequent levels of appeal on the item/service in question unless the party specifically withdraws the representative’s authority. A detailed explanation on appointing a representative can also be found in the <a href="/regulations-and-guidance/guidance/manuals/downloads/clm104c29pdf.pdf" data-entity-type="media" data-entity-uuid="891e259b-db99-48d7-8457-f7433235b174" data-entity-substitution="canonical" title="Chapter 29 - Appeals of Claims Decisions">Medicare Claims Processing Manual Publication 100-4, chapter 29 (PDF)</a>, section 270.</p><h2><strong>Expedited Determination Appeals Process (Some Part A claims only)</strong></h2><p>Home Health Agencies (HHAs), Skilled Nursing Facilities (SNFs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), and Hospices caring for beneficiaries enrolled in Original Medicare are required to notify beneficiaries of their right to an expedited review process when these providers anticipate that Medicare coverage of their services will end before they have finished providing them. Hospitals are also required to notify hospitalized inpatient Original Medicare beneficiaries of their hospital discharge appeal rights and their right to appeal a discharge decision.</p><p>For detailed information about the expedited determination appeals process, see the CMS.gov Expedited Determination Beneficiary Notices webpage sections at <a href="/medicare/forms-notices/beneficiary-notices-initiative">Medicare/Medicare-General-Information/BNI/FFS-Expedited-Determination-Notices</a>. For information on hospital discharge appeal rights, refer to <a href="/medicare/forms-notices/beneficiary-notices-initiative/ffs-ma-im" data-entity-type="node" data-entity-uuid="937f8f58-face-49d7-ab8a-ddcde3b65c91" data-entity-substitution="canonical" title="FFS & MA IM">/Medicare/Medicare-General-Information/BNI/HospitalDischargeAppealNotices</a>. Applicable regulations can be found at <a href="https://www.ecfr.gov/current/title-42/part-405/subpart-J">42 CFR 405 Subpart J—Expedited Determinations and Reconsiderations of Provider Service Terminations, and Procedures for Inpatient Hospital Discharges</a>.</p></div></div> </div> </div> <div class="block block-layout-builder block-field-blocknodesection-pagefield-downloads"> <div class="content"> <span class="create-date"> </span> <div class="field field--name-field-downloads field--type-entity-reference field--label-above cms-accented-block cms-accented-block--padded"> <h2 class="field__label block-title-icon"><i class="far fa-cloud-download"></i>Downloads</h2> <ul class="field__items"> <li class="field__item"> <article class="media media--type-document media--view-mode-file-list"> <a href="/files/document/medicare-appeal-rights-certain-changes-patient-status-factsheet.pdf">Medicare Appeal Rights Certain Changes in Patient Status FactSheet (PDF)</a> </article> </li> <li class="field__item"> <article class="media media--type-document media--view-mode-file-list"> <a href="/medicare/appeals-and-grievances/orgmedffsappeals/downloads/flowchart-ffs-appeals-process.pdf">FFS Appeals Process Flowchart (PDF)</a> </article> </li> <li class="field__item"> <article class="media media--type-document media--view-mode-file-list"> <a href="/files/document/updated-notice-regarding-court-decision-concerning-certain-appeal-rights-medicare-beneficiaries.pdf">Updated Notice Regarding Court Decision Concerning Certain Appeal Rights for Medicare Beneficiaries (PDF)</a> </article> </li> <li class="field__item"> <article class="media media--type-document media--view-mode-file-list"> <a href="/files/document/medicare-appeal-rights-certain-changes-patient-status-final-rule-fact-sheet.pdf">Medicare Appeal Rights for Certain Changes in Patient Status FINAL RULE Fact Sheet (PDF)</a> </article> </li> </ul> </div> </div> </div> <div class="block block-layout-builder block-field-blocknodesection-pagefield-related-links"> <div class="content"> <span class="create-date"> </span> <div class="field field--name-field-related-links field--type-link field--label-above cms-accented-block cms-accented-block--padded"> <h2 class="field__label block-title-icon"><i class="far fa-link"></i>Related Links</h2> <ul class="field__items"> <li class="field__item"><a href=' http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedicareAppealsProcess.pdf'>Medicare Appeals Brochure Providers Physicians and Other Suppliers</a></li> <li class="field__item"><a href=' https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS012207'>Appointment of Representative Form CMS-1696</a></li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> <div class="layout--onecol-section"> <div class="ds-l-container"> <div class="ds-l-row"> <div class="ds-l-col--12"> <div class="changed-date-block"> <div class="changed-date-decorative-bar" aria-hidden="true"></div> <div class="changed-date"> <div class="field__label">Page Last Modified:</div> <div class="field__item">10/11/2024 05:18 PM</div> </div> <div class="help-link"> <a href="/node/169881" title="Help with File Formats and Plug-Ins" class="file-format-help">Help with File Formats and Plug-Ins</a> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </inner> </div> </div> </div> </main> </div> </div>  <footer class="cms--footer ds-u-padding-y--3 ds-u-lg-padding-y--5 ds-u-margin-top--4"> <div class="ds-l-container"> <div class="ds-l-row ds-u-justify-content--center footer-email-section"> <div class="ds-l-col--12 ds-l-md-col--6 ds-l-lg-col--8"> <h2>Get email updates</h2> <p>Sign up to get the latest information about your choice of CMS topics. 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