---
kind: "section"
citation: "42 C.F.R. § 431.244"
title: "42"
number: "431.244"
heading: "Hearing decisions."
url: "https://uscodex.org/cfr/42/431.244"
---

# §431.244. Hearing decisions.

- (a) Hearing recommendations or decisions must be based exclusively on evidence introduced at the hearing.
- (b) The record must consist only of—
  - (1) The transcript or recording of testimony and exhibits, or an official report containing the substance of what happened at the hearing;
  - (2) All papers and requests filed in the proceeding; and
  - (3) **The recommendation or decision of the hearing officer.**
- (c) The applicant or beneficiary must have access to the record at a convenient place and time.
- (d) In any evidentiary hearing, the decision must be a written one that—
  - (1) Summarizes the facts; and
  - (2) **Identifies the regulations supporting the decision.**
- (e) **In a <I>de novo</I> hearing, the decision must—**
  - (1) Specify the reasons for the decision; and
  - (2) **Identify the supporting evidence and regulations.**
- (f) The agency must take final administrative action as follows:
  - (1) **Ordinarily, within 90 days from—**
    - (i) The date the enrollee filed an MCO, PIHP, or PAHP appeal, not including the number of days the enrollee took to subsequently file for a State fair hearing; or
    - (ii) For all other fair hearings, the date the agency receives a request for a fair hearing in accordance with [§ 431.221(a)(1)](/cfr/42/431.221.md?p=a-1).
  - (2) As expeditiously as the enrollee's health condition requires, but no later than 3 working days after the agency receives, from the MCO, PIHP, or PAHP, the case file and information for any appeal of a denial of a service that, as indicated by the MCO, PIHP, or PAHP—
    - (i) Meets the criteria for expedited resolution as set forth in [§ 438.410(a)](/cfr/42/438.410.md?p=a) of this chapter, but was not resolved within the timeframe for expedited resolution; or
    - (ii) Was resolved within the timeframe for expedited resolution, but reached a decision wholly or partially adverse to the enrollee.
  - (3) In the case of individuals granted an expedited fair hearing in accordance with [§ 431.224(a)](/cfr/42/431.224.md?p=a)—
    - (i) For a claim related to eligibility described in [§ 431.220(a)(1)](/cfr/42/431.220.md?p=a-1), or any claim described in [§ 431.220(a)(2)](/cfr/42/431.220.md?p=a-2) (relating to a nursing facility) or [§ 431.220(a)(3)](/cfr/42/431.220.md?p=a-3) (related to preadmission and annual resident review), as expeditiously as possible and, effective no later than the date described in [§ 435.1200(i)](/cfr/42/435.1200.md?p=i) of this chapter, no later than 7 working days after the agency receives a request for expedited fair hearing; or
    - (ii) For a claim related to services or benefits described in [§ 431.220(a)(1)](/cfr/42/431.220.md?p=a-1) as expeditiously as possible and, effective no later than the date described in [§ 435.1200(i)](/cfr/42/435.1200.md?p=i) of this chapter, within the time frame in [paragraph (f)(2)](#f-2) of this section.
    - (iii) For a claim related to services or benefits described in § [431.220(a)(4)](/cfr/42/431.220.md?p=a-4), [(5)](/cfr/42/431.220.md?p=a-5) or [(6)](/cfr/42/431.220.md?p=a-6), in accordance with the time frame in [paragraph (f)(2)](#f-2) of this section.
  - (4)
    - (i) The agency must take final administrative action on a fair hearing request within the time limits set forth in this paragraph except in unusual circumstances when—
      - (A) The agency cannot reach a decision because the appellant requests a delay or fails to take a required action; or
      - (B) **There is an administrative or other emergency beyond the agency's control.**
    - (ii) The agency must document the reasons for any delay in the appellant's record.
- (g) The public must have access to all agency hearing decisions, subject to the requirements of subpart F of this part for safeguarding of information.

## Notes

### Amendments

[44 FR 17932, Mar. 29, 1979, as amended at 67 FR 41095, June 14, 2002; 81 FR 27853, May 6, 2016; 81 FR 86449, Nov. 30, 2016]

### Source

Source: 44 FR 17932, Mar. 29, 1979, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 43 FR 45188, Sept. 29, 1978, unless otherwise noted.

### Amendments

[44 FR 17932, Mar. 29, 1979, as amended at 67 FR 41095, June 14, 2002; 81 FR 27853, May 6, 2016; 81 FR 86449, Nov. 30, 2016]