Statutory Guidance

Applicable laws related to financial liability protections can be found in Title 18 (XVIII) of the Social Security Act:

• Limitation On Liability - §1879 (a) through(g)
• Refund Requirements - §§ 1834(a)(18); 1834(j)(4); 1842(l); & 1879(h)
• Statutory exclusions from Medicare benefits -  §1862(a).

Laws related to the expedited determination process:

• §1869(b)(1)(F)

Laws related to QIO review of termination of services or discharges and reconsiderations can be found in Title 11 (XI) of the Social Security Act:

• §1154
• §1155

Use the link below to access these Titles of the Social Security Act.

Regulations related to limitation of liability can be found in the Code of Federal Regulations:

• 42 CFR 411.400, 411.402, 411.404, 411.406 and 411.408 (all 411 Subpart K). 

Regulations related to expedited determinations and reconsiderations are found at:

• Non-hospital process:

            42 CFR 405.1200 and 405.1202

• Hospital process:

            42 CFR 405.1206 and 405.1208

• Reconsideration process:

            42 CFR 405.1204

Use the link below to access the Code of Federal Regulations.  Print this page to assist with your search.