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Notes

42 C.F.R. §§ 498.22–498.25

4 sections in range

§498.22. Reconsideration.

42 C.F.R. § 498.22

(a)
Right to reconsideration. CMS or one of its contractors reconsiders an initial determination that affects a prospective provider or supplier, or a hospital seeking to qualify to claim payment for all emergency hospital services furnished in a calendar year, if the affected party files a written request in accordance with paragraphs (b) and (c) of this section. For denial or revocation of enrollment, prospective providers and suppliers and providers and suppliers have a right to reconsideration.
(b)
Request for reconsideration: Manner and timing. The affected party specified in paragraph (a) of this section, if dissatisfied with the initial determination may request reconsideration by filing the request—
(1)
With CMS or with the State survey agency, or in the case of prospective supplier the entity specified in the notice of initial determination;
(2)
Directly or through its legal representative or other authorized official; and
(3)
Within 60 days from receipt of the notice of initial determination, unless the time is extended in accordance with paragraph (d) of this section. The date of receipt will be presumed to be 5 days after the date on the notice unless there is a showing that it was, in fact, received earlier or later.
(c)
Content of request. The request for reconsideration must state the issues, or the findings of fact with which the affected party disagrees, and the reasons for disagreement.
(d)
Extension of time to file a request for reconsideration.
(1)
If the affected party is unable to file the request within the 60 days specified in paragraph (b) of this section, it may file a written request with CMS, stating the reasons why the request was not filed timely.
(2)
CMS will extend the time for filing a request for reconsideration if the affected party shows good cause for missing the deadline.
Notes, amendments, and revision history

Amendments

[52 FR 22446, June 12, 1987, as amended at 73 FR 36462, June 27, 2008]

Authority

Authority: 42 U.S.C. 1302, 1320a-7j, and 1395hh.

Source

Source: 52 FR 22446, June 12, 1987, unless otherwise noted.

Amendments

[52 FR 22446, June 12, 1987, as amended at 73 FR 36462, June 27, 2008]

§498.23. Withdrawal of request for reconsideration.

42 C.F.R. § 498.23

A request for reconsideration is considered withdrawn if the requestor files a written withdrawal request before CMS mails the notice of reconsidered determination, and CMS approves the withdrawal request.
Notes, amendments, and revision history

Authority

Authority: 42 U.S.C. 1302, 1320a-7j, and 1395hh.

Source

Source: 52 FR 22446, June 12, 1987, unless otherwise noted.

§498.24. Reconsidered determination.

42 C.F.R. § 498.24

When a request for reconsideration has been properly filed in accordance with § 498.22, CMS—
(a)
Receives written evidence and statements that are relevant and material to the matters at issue and are submitted within a reasonable time after the request for reconsideration;
(b)
Considers the initial determination, the findings on which the initial determination was based, the evidence considered in making the initial determination, and any other written evidence submitted under paragraph (a) of this section, taking into account facts relating to the status of the prospective provider or supplier subsequent to the initial determination; and
(c)
Makes a reconsidered determination, affirming or modifying the initial determination and the findings on which it was based.
Notes, amendments, and revision history

Authority

Authority: 42 U.S.C. 1302, 1320a-7j, and 1395hh.

Source

Source: 52 FR 22446, June 12, 1987, unless otherwise noted.

§498.25. Notice and effect of reconsidered determination.

42 C.F.R. § 498.25

(a)
Notice.
(1)
CMS mails notice of a reconsidered determination to the affected party.
(2)
The notice gives the reasons for the determination.
(3)
If the determination is adverse, the notice specifies the conditions or requirements of law or regulations that the affected party fails to meet, and informs the party of its right to a hearing.
(b)
Effect. A reconsidered determination is binding unless—
(1)
CMS or the OIG, as appropriate, further revises the revised determination; or
(2)
The revised determination is reversed or modified by a hearing decision.
Notes, amendments, and revision history

Authority

Authority: 42 U.S.C. 1302, 1320a-7j, and 1395hh.

Source

Source: 52 FR 22446, June 12, 1987, unless otherwise noted.