Title 42

PART 405 SUBPART i

Subpart I - Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B) Source:70 FR 11472, Mar. 8, 2005, unless otherwise noted.

42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).
Source:

42:2.0.1.2.6.9.25	SUBJGRP 25	Initial Determinations
42:2.0.1.2.6.9.25.1	SECTION 405.900	405.900 Basis and scope.
42:2.0.1.2.6.9.25.2	SECTION 405.902	405.902 Definitions.
42:2.0.1.2.6.9.25.3	SECTION 405.904	405.904 Medicare initial determinations, redeterminations and appeals: General description.
42:2.0.1.2.6.9.25.4	SECTION 405.906	405.906 Parties to the initial determinations, redeterminations, reconsiderations, hearings, and reviews.
42:2.0.1.2.6.9.25.5	SECTION 405.908	405.908 Medicaid State agencies.
42:2.0.1.2.6.9.25.6	SECTION 405.910	405.910 Appointed representatives.
42:2.0.1.2.6.9.25.7	SECTION 405.912	405.912 Assignment of appeal rights.
42:2.0.1.2.6.9.25.8	SECTION 405.920	405.920 Initial determinations.
42:2.0.1.2.6.9.25.9	SECTION 405.921	405.921 Notice of initial determination.
42:2.0.1.2.6.9.25.10	SECTION 405.922	405.922 Time frame for processing initial determinations.
42:2.0.1.2.6.9.25.11	SECTION 405.924	405.924 Actions that are initial determinations.
42:2.0.1.2.6.9.25.12	SECTION 405.925	405.925 Decisions of utilization review committees.
42:2.0.1.2.6.9.25.13	SECTION 405.926	405.926 Actions that are not initial determinations.
42:2.0.1.2.6.9.25.14	SECTION 405.927	405.927 Initial determinations subject to the reopenings process.
42:2.0.1.2.6.9.25.15	SECTION 405.928	405.928 Effect of the initial determination.
42:2.0.1.2.6.9.26	SUBJGRP 26	Redeterminations
42:2.0.1.2.6.9.26.16	SECTION 405.940	405.940 Right to a redetermination.
42:2.0.1.2.6.9.26.17	SECTION 405.942	405.942 Time frame for filing a request for a redetermination.
42:2.0.1.2.6.9.26.18	SECTION 405.944	405.944 Place and method of filing a request for a redetermination.
42:2.0.1.2.6.9.26.19	SECTION 405.946	405.946 Evidence to be submitted with the redetermination request.
42:2.0.1.2.6.9.26.20	SECTION 405.947	405.947 Notice to the beneficiary of applicable plan's request for a redetermination.
42:2.0.1.2.6.9.26.21	SECTION 405.948	405.948 Conduct of a redetermination.
42:2.0.1.2.6.9.26.22	SECTION 405.950	405.950 Time frame for making a redetermination.
42:2.0.1.2.6.9.26.23	SECTION 405.952	405.952 Withdrawal or dismissal of a request for a redetermination.
42:2.0.1.2.6.9.26.24	SECTION 405.954	405.954 Redetermination.
42:2.0.1.2.6.9.26.25	SECTION 405.956	405.956 Notice of a redetermination.
42:2.0.1.2.6.9.26.26	SECTION 405.958	405.958 Effect of a redetermination.
42:2.0.1.2.6.9.27	SUBJGRP 27	Reconsideration
42:2.0.1.2.6.9.27.27	SECTION 405.960	405.960 Right to a reconsideration.
42:2.0.1.2.6.9.27.28	SECTION 405.962	405.962 Timeframe for filing a request for a reconsideration.
42:2.0.1.2.6.9.27.29	SECTION 405.964	405.964 Place and method of filing a request for a reconsideration.
42:2.0.1.2.6.9.27.30	SECTION 405.966	405.966 Evidence to be submitted with the reconsideration request.
42:2.0.1.2.6.9.27.31	SECTION 405.968	405.968 Conduct of a reconsideration.
42:2.0.1.2.6.9.27.32	SECTION 405.970	405.970 Timeframe for making a reconsideration following a contractor redetermination.
42:2.0.1.2.6.9.27.33	SECTION 405.972	405.972 Withdrawal or dismissal of a request for reconsideration or review of a contractor's dismissal of a request for redetermination.
42:2.0.1.2.6.9.27.34	SECTION 405.974	405.974 Reconsideration and review of a contractor's dismissal of a request for redetermination.
42:2.0.1.2.6.9.27.35	SECTION 405.976	405.976 Notice of a reconsideration.
42:2.0.1.2.6.9.27.36	SECTION 405.978	405.978 Effect of a reconsideration.
42:2.0.1.2.6.9.28	SUBJGRP 28	Reopenings
42:2.0.1.2.6.9.28.37	SECTION 405.980	405.980 Reopening of initial determinations, redeterminations, reconsiderations, decisions, and reviews.
42:2.0.1.2.6.9.28.38	SECTION 405.982	405.982 Notice of a revised determination or decision.
42:2.0.1.2.6.9.28.39	SECTION 405.984	405.984 Effect of a revised determination or decision.
42:2.0.1.2.6.9.28.40	SECTION 405.986	405.986 Good cause for reopening.
42:2.0.1.2.6.9.29	SUBJGRP 29	Expedited Access to Judicial Review
42:2.0.1.2.6.9.29.41	SECTION 405.990	405.990 Expedited access to judicial review.
42:2.0.1.2.6.9.30	SUBJGRP 30	ALJ Hearings
42:2.0.1.2.6.9.30.42	SECTION 405.1000	405.1000 Hearing before an ALJ and decision by an ALJ or attorney adjudicator: General rule.
42:2.0.1.2.6.9.30.43	SECTION 405.1002	405.1002 Right to an ALJ hearing.
42:2.0.1.2.6.9.30.44	SECTION 405.1004	405.1004 Right to a review of QIC notice of dismissal.
42:2.0.1.2.6.9.30.45	SECTION 405.1006	405.1006 Amount in controversy required for an ALJ hearing and judicial review.
42:2.0.1.2.6.9.30.46	SECTION 405.1008	405.1008 Parties to the proceedings on a request for an ALJ hearing.
42:2.0.1.2.6.9.30.47	SECTION 405.1010	405.1010 When CMS or its contractors may participate in the proceedings on a request for an ALJ hearing.
42:2.0.1.2.6.9.30.48	SECTION 405.1012	405.1012 When CMS or its contractors may be a party to a hearing.
42:2.0.1.2.6.9.30.49	SECTION 405.1014	405.1014 Request for an ALJ hearing or a review of a QIC dismissal.
42:2.0.1.2.6.9.30.50	SECTION 405.1016	405.1016 Time frames for deciding an appeal of a QIC reconsideration or escalated request for a QIC reconsideration.
42:2.0.1.2.6.9.30.51	SECTION 405.1018	405.1018 Submitting evidence.
42:2.0.1.2.6.9.30.52	SECTION 405.1020	405.1020 Time and place for a hearing before an ALJ.
42:2.0.1.2.6.9.30.53	SECTION 405.1022	405.1022 Notice of a hearing before an ALJ.
42:2.0.1.2.6.9.30.54	SECTION 405.1024	405.1024 Objections to the issues.
42:2.0.1.2.6.9.30.55	SECTION 405.1026	405.1026 Disqualification of the ALJ or attorney adjudicator.
42:2.0.1.2.6.9.30.56	SECTION 405.1028	405.1028 Review of evidence submitted by parties.
42:2.0.1.2.6.9.30.57	SECTION 405.1030	405.1030 ALJ hearing procedures.
42:2.0.1.2.6.9.30.58	SECTION 405.1032	405.1032 Issues before an ALJ or attorney adjudicator.
42:2.0.1.2.6.9.30.59	SECTION 405.1034	405.1034 Requesting information from the QIC.
42:2.0.1.2.6.9.30.60	SECTION 405.1036	405.1036 Description of an ALJ hearing process.
42:2.0.1.2.6.9.30.61	SECTION 405.1037	405.1037 Discovery.
42:2.0.1.2.6.9.30.62	SECTION 405.1038	405.1038 Deciding a case without a hearing before an ALJ.
42:2.0.1.2.6.9.30.63	SECTION 405.1040	405.1040 Prehearing and posthearing conferences.
42:2.0.1.2.6.9.30.64	SECTION 405.1042	405.1042 The administrative record.
42:2.0.1.2.6.9.30.65	SECTION 405.1044	405.1044 Consolidated proceedings.
42:2.0.1.2.6.9.30.66	SECTION 405.1046	405.1046 Notice of an ALJ or attorney adjudicator decision.
42:2.0.1.2.6.9.30.67	SECTION 405.1048	405.1048 The effect of an ALJ's or attorney adjudicator's decision.
42:2.0.1.2.6.9.30.68	SECTION 405.1050	405.1050 Removal of a hearing request from OMHA to the Council.
42:2.0.1.2.6.9.30.69	SECTION 405.1052	405.1052 Dismissal of a request for a hearing before an ALJ or request for review of a QIC dismissal.
42:2.0.1.2.6.9.30.70	SECTION 405.1054	405.1054 Effect of dismissal of a request for a hearing or request for review of QIC dismissal.
42:2.0.1.2.6.9.30.71	SECTION 405.1056	405.1056 Remands of requests for hearing and requests for review.
42:2.0.1.2.6.9.30.72	SECTION 405.1058	405.1058 Effect of a remand.
42:2.0.1.2.6.9.31	SUBJGRP 31	Applicability of Medicare Coverage Policies
42:2.0.1.2.6.9.31.73	SECTION 405.1060	405.1060 Applicability of national coverage determinations (NCDs).
42:2.0.1.2.6.9.31.74	SECTION 405.1062	405.1062 Applicability of local coverage determinations and other policies not binding on the ALJ or attorney adjudicator and Council.
42:2.0.1.2.6.9.31.75	SECTION 405.1063	405.1063 Applicability of laws, regulations, CMS Rulings, and precedential decisions.
42:2.0.1.2.6.9.32	SUBJGRP 32	Medicare Appeals Council Review
42:2.0.1.2.6.9.32.76	SECTION 405.1100	405.1100 Medicare Appeals Council review: General.
42:2.0.1.2.6.9.32.77	SECTION 405.1102	405.1102 Request for Council review when ALJ or attorney adjudicator issues decision or dismissal.
42:2.0.1.2.6.9.32.78	SECTION 405.1106	405.1106 Where a request for review or escalation may be filed.
42:2.0.1.2.6.9.32.79	SECTION 405.1108	405.1108 Council actions when request for review or escalation is filed.
42:2.0.1.2.6.9.32.80	SECTION 405.1110	405.1110 Council reviews on its own motion.
42:2.0.1.2.6.9.32.81	SECTION 405.1112	405.1112 Content of request for review.
42:2.0.1.2.6.9.32.82	SECTION 405.1114	405.1114 Dismissal of request for review.
42:2.0.1.2.6.9.32.83	SECTION 405.1116	405.1116 Effect of dismissal of request for Council review or request for hearing.
42:2.0.1.2.6.9.32.84	SECTION 405.1118	405.1118 Obtaining evidence from the Council.
42:2.0.1.2.6.9.32.85	SECTION 405.1120	405.1120 Filing briefs with the Council.
42:2.0.1.2.6.9.32.86	SECTION 405.1122	405.1122 What evidence may be submitted to the Council.
42:2.0.1.2.6.9.32.87	SECTION 405.1124	405.1124 Oral argument.
42:2.0.1.2.6.9.32.88	SECTION 405.1126	405.1126 Case remanded by the Council.
42:2.0.1.2.6.9.32.89	SECTION 405.1128	405.1128 Action of the Council.
42:2.0.1.2.6.9.32.90	SECTION 405.1130	405.1130 Effect of the Council's decision.
42:2.0.1.2.6.9.32.91	SECTION 405.1132	405.1132 Request for escalation to Federal court.
42:2.0.1.2.6.9.32.92	SECTION 405.1134	405.1134 Extension of time to file action in Federal district court.
42:2.0.1.2.6.9.32.93	SECTION 405.1136	405.1136 Judicial review.
42:2.0.1.2.6.9.32.94	SECTION 405.1138	405.1138 Case remanded by a Federal district court.
42:2.0.1.2.6.9.32.95	SECTION 405.1140	405.1140 Council review of ALJ decision in a case remanded by a Federal district court.