---
kind: "section"
citation: "42 C.F.R. § 422.2610"
title: "42"
number: "422.2610"
heading: "Hearing official review."
url: "https://uscodex.org/cfr/42/422.2610"
---

# §422.2610. Hearing official review.

- (a) **Time for filing a request.** A MA organization must file with CMS a request for a hearing official review within 30 calendar days from the date of the independent reviewer's issuance of a reconsideration determination.
- (b) **Content of the request.**
  - (1) The request must be in writing and must specify the findings or issues in the reconsideration decision with which the MA organization disagrees and the reasons for the disagreements.
  - (2) The MA organization must submit with its request all supporting documentation, evidence, and substantiation that it wants to be considered.
  - (3) No new evidence may be submitted.
  - (4) Documentation, evidence, or substantiation submitted after the filing of the request will not be considered.
- (c) **CMS rebuttal.** CMS may file a rebuttal to the MA organization's hearing official review request.
  - (1) The rebuttal must be submitted within 30 calendar days of the MA organization's submission of its hearing official review request.
  - (2) CMS sends its rebuttal to the MA organization at the same time it is submitted to the hearing official.
- (d) **Conducting a review.** A CMS-designated hearing official conducts the hearing on the record.
  - (1) The hearing is not to be conducted live or via telephone unless the hearing official, in his or her sole discretion, requests a live or telephonic hearing.
  - (2) In all cases, the hearing official's review is limited to information that meets one or more of the following:
    - (i) **The Part C RAC used in making its determinations.**
    - (ii) **The independent reviewer used in making its determinations.**
    - (iii) **The MA organization submits with its hearing request.**
    - (iv) **CMS submits in accordance with paragraph (c) of this section.**
  - (3) Neither the MA organization nor CMS may submit new evidence.
- (e) **Hearing official decision.** The CMS hearing official decides the case within 60 days and sends a written decision to the MA organization and CMS, explaining the basis for the decision.
- (f) **Effect of hearing official decision.** The hearing official's decision is final and binding, unless the decision is reversed or modified by the CMS Administrator in accordance with [§ 422.2615](/cfr/42/422.2615.md).

## Notes

### Source

Source: 79 FR 29961, May 23, 2014, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1306, 1395w-21 through 1395w-28, and 1395hh.

### Source

Source: 63 FR 18134, Apr. 14, 1998, unless otherwise noted.