The current Medicare appeals process was established by various statutes and implementing regulations. The table below lists some of the statutes and regulations that govern the appeals process for Medicare claims and entitlement, Medicare Advantage organization determination, and Medicare prescription drug coverage determination appeals, as well as select OMHA and Centers for Medicare & Medicaid (CMS) program guidance.

*Statutory citations are given to the Social Security Act, as amended, with United States Code (U.S.C.) equivalents as parentheticals. However, please note that the online version of the U.S.C. may be more current than the online version of the Social Security Act.

The CMS Administrator also issues Rulings that serve as precedent final opinions and orders and statements of policy and interpretation. CMS Rulings are binding on all CMS components and OMHA adjudicators.

• CMS Rulings issued prior to 1995
• CMS Rulings issued in 1995 or later

?The Chair of the Departmental Appeals Board (DAB) may designate certain Medicare Appeals Council decisions as precedential. These precedential decisions are binding on all HHS components, including OMHA adjudicators.