# Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures
> **Centers for Medicare and Medicaid Services** · Final rule. · Published 2017-01-17 · Effective 2017-03-20 · 82 FR 4974
## Document
- **Document number:** 2016-32058
- **Category:** medicare
- **Sub-agency:** Centers for Medicare and Medicaid Services
- **Federal Register citation:** 82 FR 4974
- **CFR reference:** 42 CFR 401
- **Publication date:** 2017-01-17
- **Effective date:** 2017-03-20
- **HHS docket:** HHS-2016-79
## Abstract

This final rule revises the procedures that the Department of Health and Human Services (HHS) follows at the Administrative Law Judge (ALJ) level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as well as appeals of Medicare beneficiary enrollment and entitlement determinations, and certain Medicare premium appeals. In addition, this final rule revises procedures that the Department of Health and Human Services follows at the Centers for Medicare & Medicaid Services (CMS) and the Medicare Appeals Council (Council) levels of appeal for certain matters affecting the ALJ level.

## Source
- [Federal Register document](https://www.federalregister.gov/documents/2017/01/17/2016-32058/medicare-program-changes-to-the-medicare-claims-and-entitlement-medicare-advantage-organization)
---
*AI Analytics · CC0 1.0*