---
kind: "range"
citation: "42 C.F.R. §§ 498.22–498.25"
title: "42"
from: "498.22"
to: "498.25"
count: 4
url: "https://uscodex.org/cfr/42/498.22..498.25"
---

# §498.22. Reconsideration.

- (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)](#b) and [(c)](#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)](#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)](#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)](#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.

# §498.23. Withdrawal of request for reconsideration.


A request for reconsideration is considered withdrawn if the requestor files a written withdrawal request before CMS mails the notice of reconsidered determination, and CMS approves the withdrawal request.


# §498.24. Reconsidered determination.


When a request for reconsideration has been properly filed in accordance with [§ 498.22](/cfr/42/498.22.md), 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)](#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.

# §498.25. Notice and effect of reconsidered determination.

- (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.**