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LAWS AND REGULATIONS
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MAXIMUS Federal Services makes its decisions based on Medicare law and policies. Medicare managed care plans are required to follow all Medicare law and policies, including LMRPs (Local Medical Review Policies - policies set by Medicare Fee-for-Service Contractors in your geographic area).
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The decision letter from MAXIMUS Federal Services about your appeal with your Medicare managed care plan will contain a reference to the Medicare law or policy we used to make our decision. Select the appropriate link to help you get access to the actual policy.
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You may access the relevant Medicare laws (e.g. Social Security Act) and supporting regulations (e.g. 42 CFR §____) by selecting "Medicare Laws and Regulations."
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Select "All Federal Regulations" to access the United States Government Printing Office. You can access all federal regulations, including Medicare regulations on this web site. There are also many other federal publications available on this web site.
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Select "Medicare Program Manuals" to obtain access to CMS Medicare policy manuals.
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Select the Medicare Managed Care Manual to access CMS program and policy guidance to Medicare Managed Care Plans.
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You can access the most recent LMRPs (Local Medical Review Policies) by selecting the LMRP link.
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CMS Operational Policy Letters (OPL) provide program guidance to Medicare managed care plans. Select OPL to be linked to the index for CMS OPL.
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Select HIPAA to find information regarding the Health Insurance Portability and Accountability Act (HIPAA).
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