Scheme Nickname: 
Medicare Advantage (MA) and Prescription Drug (PD) Appeals

Medicare Advantage (MA) and Prescription Drug (PD) Plans are permitted to participate in the Medicare Program under Sections 1857 and 1860D-12 of the Social security Act and regulations at 42 C.F.R. Sections 422.500 and 423.500 et seq. If the Centers for Medicare & Medicaid Services (CMS) denies an application to qualify as a MA or A PD Plan or takes adverse action (termination, non-renewal, intermediate sanction) against an existing MA or PD Plan, the applicant or existing MA or PD Plan is entitled to request a hearing before a CMS Hearing Officer, (42 C.F.R. Sections 422.660 and 423.650 et seq.) Additionally, the CMS Hearing Officer's decisions may be reviewed by the CMS Administrator in accordance with 42 C.F.R. Sections 423.666 and 422.690.

Comments/Notes on Adjudication Structure: 
Types of Adjudication: 
Type A
Type B
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