§478.28. Qualifications of a reconsideration reviewer.
42 C.F.R. § 478.28
A reconsideration reviewer must be someone who is—
Qualified under § 476.98 of this chapter to make an initial determination.
Not the individual who made the initial denial determination.
A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review.
Notes, amendments, and revision history
Amendments
[50 FR 15330, Apr. 17, 1985, as amended at 77 FR 68563, Nov. 15, 2012]
Source
Source: 50 FR 15372, Apr. 17, 1985, unless otherwise noted. Redesignated at 64 FR 66279, Nov. 24, 1999.
Authority
Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).
Amendments
[50 FR 15330, Apr. 17, 1985, as amended at 77 FR 68563, Nov. 15, 2012]