Statutory Guidance

Financial Liability Protections

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).

Expedited Determination Process:

• §1869(b)(1)(F)

QIO review of termination of services or discharge and reconsideration can be found in Title 11 (XI) of the Social Security Act:

• §1154
• §1155

Use the link below in the "Related Links" section 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 reconsideration 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.