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HHS/CMS RIN: 0938-AO87 Publication ID: Fall 2008 
Title: Application of Certain Appeals Provisions to the Medicare Prescription Drug Appeals Process (CMS-4127-F) 
Abstract: The voluntary prescription drug benefit program was enacted into law by section 101 of title 1 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). The implementing regulations for the Part D program were published in a final rule on January 28, 2005, and became effective March 22, 2005. These regulations provide that the Medicare Advantage (MA) rules regarding appeals and reopenings will apply to the Part D appeals process to the extent they are appropriate. The MA regulations in turn apply the fee-for-service (FFS) appeals regulations (concerning the administrative review and hearing processes and representation of parties under titles II and XVIII of the Act) to the extent they are appropriate. Based on this regulatory framework, we noted in the January 28, 2005, rule that differences in the appeals procedures for Part D enrollees would be addressed in a future Part D rulemaking document. This rule provides additional guidance on the differences in appeals procedures for Part D enrollees by proposing more detailed regulations governing Part D appeals at the ALJ, MAC, and Federal district court levels and reopenings of determinations and decisions that follow the Part A and Part B procedures set forth in the part 405 rule, as appropriate. 
Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Long-Term Actions 
Major: No  Unfunded Mandates: No 
CFR Citation: 42 CFR 423   
Legal Authority: sec 1102, 1860D-1 to 1860D-42, and 1871 of the Social Security Act (42 USC 1302, 1395w-101 to 1395w-152, and 1395hh)   
Legal Deadline:  None
Timetable:
Action Date FR Cite
NPRM  03/17/2008  73 FR 14341   
NPRM Comment Period End  05/16/2008    
Final Action  03/00/2011    
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Agency Contact:
Anthony Culotta
Director, Medicare Enrollment and Appeals Group
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Mailstop C2-12-16, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-4661
Email: anthony.culotta@cms.hhs.gov