Maximus makes its decisions based on Medicare law and coverage policies. Medicare managed care plans are required to follow all Medicare law and coverage policies, including LCDs (Local Coverage Determinations - coverage policies set by Medicare Fee-for-Service Contractors in your geographic area).
The decision letter from Maximus 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.
Select "Social Security Act" to access the relevant Medicare laws.
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.
Select "Medicare Program Manuals" to obtain access to CMS Medicare policy manuals. Please review the brochure "Navigating the CMS Online Manual System" if you need assistance.
Select the Medicare Managed Care Manual to access CMS program and policy guidance to Medicare Managed Care Plans.
You can access the LCDs (Local Coverage Determinations) by selecting the Medicare Coverage link.
Select HIPAA to find information regarding the Health Insurance Portability and Accountability Act (HIPAA).
Medicare Regulations and Guidance
Navigating the CMS Online Manual System (explanatory brochure)