42 CFR § 438.228 - Grievance and appeal systems.
---
identifier: "/us/cfr/t42/s438.228"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 438.228 - Grievance and appeal systems."
title_number: 42
title_name: "Public Health"
section_number: "438.228"
section_name: "Grievance and appeal systems."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "C"
subchapter_name: "MEDICAL ASSISTANCE PROGRAMS"
part_number: "438"
part_name: "MANAGED CARE"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302."
regulatory_source: "67 FR 41095, June 14, 2002, unless otherwise noted."
cfr_part: "438"
---
# 438.228 Grievance and appeal systems.
(a) The State must ensure, through its contracts, that each MCO, PIHP, and PAHP has in effect a grievance and appeal system that meets the requirements of subpart F of this part.
(b) If the State delegates to the MCO, PIHP, or PAHP responsibility for notice of action under subpart E of part 431 of this chapter, the State must conduct random reviews of each delegated MCO, PIHP, or PAHP and its providers and subcontractors to ensure that they are notifying enrollees in a timely manner.