42 C.F.R. § 423.602 Notice of reconsideration determination by the independent review entity.
Title 42 - Public Health
(a) Responsibility for the notice. When the IRE makes its reconsideration determination, it is responsible for mailing a notice of its determination to the enrollee and the Part D plan sponsor, and for sending a copy to CMS. (b) Content of the notice. The notice must— (1) State the specific reasons for the IRE's decision in understandable language; (2) If the reconsideration determination is adverse (that is, does not completely reverse the adverse coverage determination by the Part D plan sponsor), inform the enrollee of his or her right to an ALJ hearing if the amount in controversy meets the threshold requirement under §423.610; (3) Describe the procedures that must be followed to obtain an ALJ hearing; and (4) Comply with any other requirements specified by CMS.
Title 42: Public Health
PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
Subpart M—Grievances, Coverage Determinations, and Appeals
§ 423.602 Notice of reconsideration determination by the independent review entity.
