---
kind: "section"
citation: "42 C.F.R. § 405.970"
title: "42"
number: "405.970"
heading: "Timeframe for making a reconsideration following a contractor redetermination."
url: "https://uscodex.org/cfr/42/405.970"
---

# §405.970. Timeframe for making a reconsideration following a contractor redetermination.

- (a) **General rule.** Within 60 calendar days of the date the QIC receives a timely filed request for reconsideration following a contractor redetermination or any additional time provided by [paragraph (b)](#b) of this section, the QIC mails, or otherwise transmits to the parties at their last known addresses, written notice of—
  - (1) The reconsideration;
  - (2) Its inability to complete its review within 60 calendar days in accordance with [paragraphs (c) through (e)](#c..e) of this section; or
  - (3) **Dismissal.**
- (b) **Exceptions.**
  - (1) If a QIC grants an appellant's request for an extension of the 180 calendar day filing deadline made in accordance with [§ 405.962(b)](/cfr/42/405.962.md?p=b), the QIC's 60 calendar day decision-making timeframe begins on the date the QIC receives the late filed request for reconsideration following a contractor redetermination, or when the request for an extension that meets the requirements of [§ 405.962(b)](/cfr/42/405.962.md?p=b) is granted, whichever is later.
  - (2) If a QIC receives timely requests for reconsideration following a contractor redetermination from multiple parties, consistent with [§ 405.964(c)](/cfr/42/405.964.md?p=c), the QIC must issue a reconsideration, notice that it cannot complete its review, or dismissal within 60 calendar days for each submission of the latest filed request.
  - (3) Each time a party submits additional evidence after the request for reconsideration following a contractor redetermination is filed, the QIC's 60 calendar day decisionmaking timeframe is extended by up to 14 calendar days for each submission, consistent with [§ 405.966(b)](/cfr/42/405.966.md?p=b).
- (c) **Responsibilities of the QIC.** Within 60 calendar days of receiving a request for a reconsideration following a contractor redetermination, or any additional time provided for under [paragraph (b)](#b) of this section, a QIC must take one of the following actions:
  - (1) Notify all parties of its reconsideration, consistent with [§ 405.976](/cfr/42/405.976.md).
  - (2) Notify the parties that it cannot complete the reconsideration by the deadline specified in [paragraph (b)](#b) of this section and offer the appellant the opportunity to escalate the appeal to OMHA. The QIC continues to process the reconsideration unless it receives a written request from the appellant to escalate the case to OMHA after the adjudication period has expired.
- (d) **Responsibilities of the appellant.** If an appellant wishes to exercise the option of escalating the case to OMHA, the appellant must notify the QIC in writing.
- (e) **Actions following appellant's notice.**
  - (1) If the appellant fails to notify the QIC, or notifies the QIC that the appellant does not choose to escalate the case, the QIC completes its reconsideration following a contractor redetermination and notifies the appellant of its action consistent with [§ 405.972](/cfr/42/405.972.md) or [§ 405.976](/cfr/42/405.976.md).
  - (2) If the appellant notifies the QIC that the appellant wishes to escalate the case, the QIC must take one of the following actions within 5 calendar days of receipt of the notice or 5 calendar days from the end of the applicable adjudication period under paragraph [(a)](#a) or [(b)](#b) of this section:
    - (i) Complete its reconsideration following a contractor redetermination and notify all parties of its decision consistent with [§ 405.972](/cfr/42/405.972.md) or [§ 405.976](/cfr/42/405.976.md).
    - (ii) **Acknowledge the escalation notice in writing and forward the case file to OMHA.**

## Notes

### Amendments

[70 FR 11472, Mar. 8, 2005, as amended at 70 FR 37702, June 30, 2005; 74 FR 65334, Dec. 9, 2009; 82 FR 5107, Jan. 17, 2017; 84 FR 19870, May 7, 2019]

### Source

Source: 70 FR 11472, Mar. 8, 2005, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).

### Amendments

[70 FR 11472, Mar. 8, 2005, as amended at 70 FR 37702, June 30, 2005; 74 FR 65334, Dec. 9, 2009; 82 FR 5107, Jan. 17, 2017; 84 FR 19870, May 7, 2019]