42 CFR 423.2600
§ 423.2600 Payment appeals.
United States · 42 CFR — Public Health · Status: effective
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- Citation
- 42 CFR 423.2600, § 423.2600 Payment appeals, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/205133
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Full text
Medicare Part D plan sponsors may appeal program integrity prescription drug event record review audit determinations.
(a) Issues eligible for appeal.
(1) CMS's application of Part D policy(ies).
(2) Factual or data errors.
(b) Issues ineligible for appeal.
(1) The Part D plan sponsor's failure to submit documentation in the timeframes specified by CMS during the audit.
(2) The program integrity prescription drug event record review audit methodology.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.