Effect of partial lease of facilities Sample Clauses

Effect of partial lease of facilities. If the MA organization leases part of its facilities to another entity, its con- tract with CMS remains in effect while CMS surveys the MA organization to determine whether it continues to be in compliance with the applicable re- quirements and qualifying conditions specified in subpart K of this part. [50 FR 1346, Jan. 10, 1985; 50 FR 20570, May 17, 1985, as amended at 58 FR 38079, July 15, 1993; 00 XX 00000, Xxxx. 1, 1995. Redesignated and amended at 63 FR 35067, 35106, June 26, 1998; 70 FR 52027, Sept. 1, 2005] SOURCE: 63 FR 35107, June 26, 1998, unless otherwise noted. (a) Statutory basis. (1) Section 1852(f) of the Act provides that an MA organi- zation must establish meaningful grievance procedures. (2) Section 1852(g) of the Act estab- lishes requirements that an MA organi- zation must meet concerning organiza- tion determinations and appeals. (3) Section 1869 of the Act specifies the amount in controversy needed to pursue a hearing and judicial review and authorizes representatives to act on behalf of individuals that seek ap- peals. These provisions are incor- porated for MA appeals by section 1852(g)(5) of the Act and part 405 of this chapter.
Sample 1
Effect of partial lease of facilities. If the PDP sponsor leases part of its fa- cilities to another entity, its contract with CMS remains in effect while CMS surveys the PDP sponsor to determine whether it continues to be in compli- ance with the applicable requirements and qualifying conditions specified in subpart K of this part. (a) This subpart sets forth the re- quirements relating to the following: (1) Part D plan sponsors with respect to grievances, coverage determina- tions, and redeterminations. (2) Part D IRE with respect to recon- siderations. (3) Part D enrollees’ rights with re- spect to grievances, coverage deter- minations, redeterminations, and re- considerations. (b) The requirements regarding re- openings, ALJ hearings, MAC review, and Judicial review are set forth in subpart U of this chapter. [74 FR 65363, Dec. 9, 2009] As used in this subpart, unless the context indicates otherwise—
Sample 1Sample 2
Effect of partial lease of facilities. If the MA organization leases part of its facilities to another entity, its con- tract with CMS remains in effect while CMS surveys the MA organization to determine whether it continues to be in compliance with the applicable re- quirements and qualifying conditions specified in subpart K of this part. [50 FR 1346, Jan. 10, 1985; 50 FR 20570, May 17, 1985, as amended at 58 FR 38079, July 15, 1993; 60 FR 45681, Sept. 1, 1995. Redesignated and amended at 63 FR 35067, 35106, June 26, 1998; 70 FR 52027, Sept. 1, 2005] SOURCE: 63 FR 35107, June 26, 1998, unless otherwise noted. (a) Statutory basis. (1) Section 1852(f) of the Act provides that an MA organi- zation must establish meaningful grievance procedures. (2) Section 1852(g) of the Act estab- lishes requirements that an MA organi- zation must meet concerning organiza- tion determinations and appeals. (3) Section 1869 of the Act specifies the amount in controversy needed to pursue a hearing and judicial review and authorizes representatives to act on behalf of individuals that seek ap- peals. These provisions are incor- porated for MA appeals by section 1852(g)(5) of the Act and part 405 of this chapter. (4) Section 1859(f)(8) of the Act pro- vides for, to the extent feasible, uni- fying grievances and appeals proce- dures under sections 1852(f), 1852(g), 1902(a)(3), 1902(a)(5), and 1932(b)(4) of the Act for Medicare and Medicaid cov- ered items and services provided by specialized MA plans for special needs individuals described in subsection 1859(b)(6)(B)(ii) of the Act for individ- uals who are eligible under titles XVIII and XIX of the Act. Beginning January 1, 2021, procedures established under section 1859(f)(8) of the Act apply in place of otherwise applicable griev- ances and appeals procedures with re- spect to Medicare and Medicaid cov- ered items and services provided by ap- plicable integrated plans. (b) Scope. This subpart sets forth— (1) Requirements for MA organiza- tions with respect to grievance proce- dures, organization determinations, and appeal procedures. (2) The rights of MA enrollees with respect to organization determina- tions, and grievance and appeal proce- dures. (3) The rules concerning notice of noncoverage of inpatient hospital care. (4) The rules that apply when an MA enrollee requests immediate QIO re- view of a determination that he or she no longer needs inpatient hospital care. (5) Requirements for applicable inte- grated plans with respect to procedures for integrated g...
Sample 1
Effect of partial lease of facilities. If the MA organization leases part of its facilities to another entity, its con- tract with CMS remains in effect while CMS surveys the MA organization to determine whether it continues to be in compliance with the applicable re- quirements and qualifying conditions specified in subpart K of this part. [50 FR 1346, Jan. 10, 1985; 50 FR 20570, May 17, 1985, as amended at 58 FR 38079, July 15, 1993; 60 FR 45681, Sept. 1, 1995. Redesignated and amended at 63 FR 35067, 35106, June 26, 1998; 70 FR 52027, Sept. 1, 2005] SOURCE: 63 FR 35107, June 26, 1998, unless otherwise noted. (a) Statutory basis. (1) Section 1852(f) of the Act provides that an MA organi- zation must establish meaningful grievance procedures.
Sample 1
Effect of partial lease of facilities. If the PDP sponsor leases part of its fa- cilities to another entity, its contract with CMS remains in effect while CMS surveys the PDP sponsor to determine whether it continues to be in compli- ance with the applicable requirements and qualifying conditions specified in subpart K of this part. (a) This subpart sets forth the re- quirements relating to the following: (1) Part D plan sponsors with respect to grievances, coverage determina- tions, and redeterminations. (2) Part D IRE with respect to recon- siderations. (3) Part D enrollees’ rights with re- spect to grievances, coverage deter- minations, redeterminations, and re- considerations. (b) The requirements regarding re- openings, ALJ hearings, MAC review, and Judicial review are set forth in subpart U of this chapter. [74 FR 65363, Dec. 9, 2009] As used in this subpart, unless the context indicates otherwise— dividual either appointed by an en- rollee or authorized under State or other applicable law to act on behalf of the enrollee in filing a grievance, ob- taining a coverage determination, or in dealing with any of the levels of the ap- peals process. Unless otherwise stated in this subpart, the appointed rep- resentative has all of the rights and re- sponsibilities of an enrollee in filing a grievance, obtaining a coverage deter- mination, or in dealing with any of the levels of the appeals process, subject to the rules described in part 422, subpart M of this chapter.
Sample 1

Related to Effect of partial lease of facilities

  • Construction of Agreement The parties mutually acknowledge that they and their attorneys have participated in the preparation and negotiation of this Agreement. In cases of uncertainty this Agreement shall be construed without regard to which of the parties caused the uncertainty to exist.

  • Effect of Completion This agreement shall, as to any of its provisions remaining to be performed or capable of having or taking effect following Completion, remain in full force and effect notwithstanding Completion.

  • Effect of Agreement Nothing herein contained shall be deemed to require to the Trust to take any action contrary to its Declaration of Trust or its By-Laws or any applicable law, regulation or order to which it is subject or by which it is bound, or to relieve or deprive the Trustees of the Trust of their responsibility for and control of the conduct of the business and affairs of the Trust.

  • Effect of Waiver or Consent A waiver or consent, express or implied, to or of any breach or default by any Person in the performance by that Person of its obligations with respect to the Company is not a consent or waiver to or of any other breach or default in the performance by that Person of the same or any other obligations of that Person with respect to the Company. Failure on the part of a Person to complain of any act of any Person or to declare any Person in default with respect to the Company, irrespective of how long that failure continues, does not constitute a waiver by that Person of its rights with respect to that default until the applicable statute-of-limitations period has run.

Most Referenced Clauses

Most Referenced Definitions