---
kind: "section"
citation: "42 C.F.R. § 478.28"
title: "42"
number: "478.28"
heading: "Qualifications of a reconsideration reviewer."
url: "https://uscodex.org/cfr/42/478.28"
---

# §478.28. Qualifications of a reconsideration reviewer.


A reconsideration reviewer must be someone who is—

- (a) Qualified under [§ 476.98](/cfr/42/476.98.md) of this chapter to make an initial determination.
- (b) **Not the individual who made the initial denial determination.**
- (c) 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

[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]