Title 42

PART 405

Part 405 - Federal Health Insurance For The Aged And Disabled

PART 405 - FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Authority:42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).

42:2.0.1.2.5.1SUBPART A
Subpart A [Reserved]
42:2.0.1.2.5.2SUBPART B
Subpart B - Medical Services Coverage Decisions That Relate to Health Care Technology
42:2.0.1.2.5.2.21.1SECTION 405.201
   405.201 Scope of subpart and definitions.
42:2.0.1.2.5.2.21.2SECTION 405.203
   405.203 FDA categorization of investigational devices.
42:2.0.1.2.5.2.21.3SECTION 405.205
   405.205 Coverage of a Category B (Nonexperimental/investigational) device.
42:2.0.1.2.5.2.21.4SECTION 405.207
   405.207 Services related to a noncovered device.
42:2.0.1.2.5.2.21.5SECTION 405.209
   405.209 Payment for a Category B (Nonexperimental/investigational) device.
42:2.0.1.2.5.2.21.6SECTION 405.211
   405.211 Coverage of items and services in FDA-approved IDE studies.
42:2.0.1.2.5.2.21.7SECTION 405.212
   405.212 Medicare Coverage IDE study criteria.
42:2.0.1.2.5.2.21.8SECTION 405.213
   405.213 Re-evaluation of a device categorization.
42:2.0.1.2.5.2.21.9SECTION 405.215
   405.215 Confidential commercial and trade secret information.
42:2.0.1.2.5.3SUBPART C
Subpart C - Suspension of Payment, Recovery of Overpayments, and Repayment of Scholarships and Loans
42:2.0.1.2.5.3.21SUBJGRP 21
   General Provisions
42:2.0.1.2.5.3.21.1SECTION 405.301
   405.301 Scope of subpart.
42:2.0.1.2.5.3.22SUBJGRP 22
   Liability for Payments To Providers or Suppliers and Handling of Incorrect Payments
42:2.0.1.2.5.3.22.2SECTION 405.350
   405.350 Individual's liability for payments made to providers and other persons for items and services furnished the individual.
42:2.0.1.2.5.3.22.3SECTION 405.351
   405.351 Incorrect payments for which the individual is not liable.
42:2.0.1.2.5.3.22.4SECTION 405.352
   405.352 Adjustment of title XVIII incorrect payments.
42:2.0.1.2.5.3.22.5SECTION 405.353
   405.353 Certification of amount that will be adjusted against individual title II or railroad retirement benefits.
42:2.0.1.2.5.3.22.6SECTION 405.354
   405.354 Procedures for adjustment or recovery - title II beneficiary.
42:2.0.1.2.5.3.22.7SECTION 405.355
   405.355 Waiver of adjustment or recovery.
42:2.0.1.2.5.3.22.8SECTION 405.356
   405.356 Principles applied in waiver of adjustment or recovery.
42:2.0.1.2.5.3.22.9SECTION 405.357
   405.357 Notice of right to waiver consideration.
42:2.0.1.2.5.3.22.10SECTION 405.358
   405.358 When waiver of adjustment or recovery may be applied.
42:2.0.1.2.5.3.22.11SECTION 405.359
   405.359 Liability of certifying or disbursing officer.
42:2.0.1.2.5.3.23SUBJGRP 23
   Suspension and Recoupment of Payment to Providers and Suppliers and Collection and Compromise of Overpayments
42:2.0.1.2.5.3.23.12SECTION 405.370
   405.370 Definitions.
42:2.0.1.2.5.3.23.13SECTION 405.371
   405.371 Suspension, offset, and recoupment of Medicare payments to providers and suppliers of services.
42:2.0.1.2.5.3.23.14SECTION 405.372
   405.372 Proceeding for suspension of payment.
42:2.0.1.2.5.3.23.15SECTION 405.373
   405.373 Proceeding for offset or recoupment.
42:2.0.1.2.5.3.23.16SECTION 405.374
   405.374 Opportunity for rebuttal.
42:2.0.1.2.5.3.23.17SECTION 405.375
   405.375 Time limits for, and notification of, administrative determination after receipt of rebuttal statement.
42:2.0.1.2.5.3.23.18SECTION 405.376
   405.376 Suspension and termination of collection action and compromise of claims for overpayment.
42:2.0.1.2.5.3.23.19SECTION 405.377
   405.377 Withholding Medicare payments to recover Medicaid overpayments.
42:2.0.1.2.5.3.23.20SECTION 405.378
   405.378 Interest charges on overpayment and underpayments to providers, suppliers, and other entities.
42:2.0.1.2.5.3.23.21SECTION 405.379
   405.379 Limitation on recoupment of provider and supplier overpayments.
42:2.0.1.2.5.3.24SUBJGRP 24
   Repayment of Scholarships and Loans
42:2.0.1.2.5.3.24.22SECTION 405.380
   405.380 Collection of past-due amounts on scholarship and loan programs.
42:2.0.1.2.5.4SUBPART D
Subpart D - Private Contracts
42:2.0.1.2.5.4.25.1SECTION 405.400
   405.400 Definitions.
42:2.0.1.2.5.4.25.2SECTION 405.405
   405.405 General rules.
42:2.0.1.2.5.4.25.3SECTION 405.410
   405.410 Conditions for properly opting-out of Medicare.
42:2.0.1.2.5.4.25.4SECTION 405.415
   405.415 Requirements of the private contract.
42:2.0.1.2.5.4.25.5SECTION 405.420
   405.420 Requirements of the opt-out affidavit.
42:2.0.1.2.5.4.25.6SECTION 405.425
   405.425 Effects of opting-out of Medicare.
42:2.0.1.2.5.4.25.7SECTION 405.430
   405.430 Failure to properly opt-out.
42:2.0.1.2.5.4.25.8SECTION 405.435
   405.435 Failure to maintain opt-out.
42:2.0.1.2.5.4.25.9SECTION 405.440
   405.440 Emergency and urgent care services.
42:2.0.1.2.5.4.25.10SECTION 405.445
   405.445 Cancellation of opt-out and early termination of opt-out.
42:2.0.1.2.5.4.25.11SECTION 405.450
   405.450 Appeals.
42:2.0.1.2.5.4.25.12SECTION 405.455
   405.455 Application to Medicare Advantage contracts.
42:2.0.1.2.5.5SUBPART E
Subpart E - Criteria for Determining Reasonable Charges
42:2.0.1.2.5.5.25.1SECTION 405.500
   405.500 Basis.
42:2.0.1.2.5.5.25.2SECTION 405.501
   405.501 Determination of reasonable charges.
42:2.0.1.2.5.5.25.3SECTION 405.502
   405.502 Criteria for determining reasonable charges.
42:2.0.1.2.5.5.25.4SECTION 405.503
   405.503 Determining customary charges.
42:2.0.1.2.5.5.25.5SECTION 405.504
   405.504 Determining prevailing charges.
42:2.0.1.2.5.5.25.6SECTION 405.505
   405.505 Determination of locality.
42:2.0.1.2.5.5.25.7SECTION 405.506
   405.506 Charges higher than customary or prevailing charges or lowest charge levels.
42:2.0.1.2.5.5.25.8SECTION 405.507
   405.507 Illustrations of the application of the criteria for determining reasonable charges.
42:2.0.1.2.5.5.25.9SECTION 405.508
   405.508 Determination of comparable circumstances; limitation.
42:2.0.1.2.5.5.25.10SECTION 405.509
   405.509 Determining the inflation-indexed charge.
42:2.0.1.2.5.5.25.11SECTION 405.511
   405.511 Reasonable charges for medical services, supplies, and equipment.
42:2.0.1.2.5.5.25.12SECTION 405.512
   405.512 Carriers' procedural terminology and coding systems.
42:2.0.1.2.5.5.25.13SECTION 405.515
   405.515 Reimbursement for clinical laboratory services billed by physicians.
42:2.0.1.2.5.5.25.14SECTION 405.517
   405.517 Payment for drugs and biologicals that are not paid on a cost or prospective payment basis.
42:2.0.1.2.5.5.25.15SECTION 405.520
   405.520 Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional services.
42:2.0.1.2.5.5.25.16SECTION 405.534
   405.534 Limitation on payment for screening mammography services.
42:2.0.1.2.5.5.25.17SECTION 405.535
   405.535 Special rule for nonparticipating physicians and suppliers furnishing screening mammography services before January 1, 2002.
42:2.0.1.2.5.6SUBPART F
Subparts F-G [Reserved]
42:2.0.1.2.5.7SUBPART H
Subpart H - Appeals Under the Medicare Part B Program
42:2.0.1.2.5.7.25.1SECTION 405.800
   405.800 Appeals of CMS or a CMS contractor.
42:2.0.1.2.5.7.25.2SECTION 405.803
   405.803 Appeals rights.
42:2.0.1.2.5.7.25.3SECTION 405.806
   405.806 Impact of reversal of contractor determinations on claims processing.
42:2.0.1.2.5.7.25.4SECTION 405.809
   405.809 Reinstatement of provider or supplier billing privileges following corrective action.
42:2.0.1.2.5.7.25.5SECTION 405.812
   405.812 Effective date for DMEPOS supplier's billing privileges.
42:2.0.1.2.5.7.25.6SECTION 405.815
   405.815 Submission of claims.
42:2.0.1.2.5.7.25.7SECTION 405.818
   405.818 Deadline for processing provider enrollment initial determinations.
42:2.0.1.2.5.8SUBPART I
Subpart I - Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)
42:2.0.1.2.5.8.25SUBJGRP 25
   Initial Determinations
42:2.0.1.2.5.8.25.1SECTION 405.900
   405.900 Basis and scope.
42:2.0.1.2.5.8.25.2SECTION 405.902
   405.902 Definitions.
42:2.0.1.2.5.8.25.3SECTION 405.904
   405.904 Medicare initial determinations, redeterminations and appeals: General description.
42:2.0.1.2.5.8.25.4SECTION 405.906
   405.906 Parties to the initial determinations, redeterminations, reconsiderations, hearings, and reviews.
42:2.0.1.2.5.8.25.5SECTION 405.908
   405.908 Medicaid State agencies.
42:2.0.1.2.5.8.25.6SECTION 405.910
   405.910 Appointed representatives.
42:2.0.1.2.5.8.25.7SECTION 405.912
   405.912 Assignment of appeal rights.
42:2.0.1.2.5.8.25.8SECTION 405.920
   405.920 Initial determinations.
42:2.0.1.2.5.8.25.9SECTION 405.921
   405.921 Notice of initial determination.
42:2.0.1.2.5.8.25.10SECTION 405.922
   405.922 Time frame for processing initial determinations.
42:2.0.1.2.5.8.25.11SECTION 405.924
   405.924 Actions that are initial determinations.
42:2.0.1.2.5.8.25.12SECTION 405.925
   405.925 Decisions of utilization review committees.
42:2.0.1.2.5.8.25.13SECTION 405.926
   405.926 Actions that are not initial determinations.
42:2.0.1.2.5.8.25.14SECTION 405.927
   405.927 Initial determinations subject to the reopenings process.
42:2.0.1.2.5.8.25.15SECTION 405.928
   405.928 Effect of the initial determination.
42:2.0.1.2.5.8.26SUBJGRP 26
   Redeterminations
42:2.0.1.2.5.8.26.16SECTION 405.940
   405.940 Right to a redetermination.
42:2.0.1.2.5.8.26.17SECTION 405.942
   405.942 Time frame for filing a request for a redetermination.
42:2.0.1.2.5.8.26.18SECTION 405.944
   405.944 Place and method of filing a request for a redetermination.
42:2.0.1.2.5.8.26.19SECTION 405.946
   405.946 Evidence to be submitted with the redetermination request.
42:2.0.1.2.5.8.26.20SECTION 405.947
   405.947 Notice to the beneficiary of applicable plan's request for a redetermination.
42:2.0.1.2.5.8.26.21SECTION 405.948
   405.948 Conduct of a redetermination.
42:2.0.1.2.5.8.26.22SECTION 405.950
   405.950 Time frame for making a redetermination.
42:2.0.1.2.5.8.26.23SECTION 405.952
   405.952 Withdrawal or dismissal of a request for a redetermination.
42:2.0.1.2.5.8.26.24SECTION 405.954
   405.954 Redetermination.
42:2.0.1.2.5.8.26.25SECTION 405.956
   405.956 Notice of a redetermination.
42:2.0.1.2.5.8.26.26SECTION 405.958
   405.958 Effect of a redetermination.
42:2.0.1.2.5.8.27SUBJGRP 27
   Reconsideration
42:2.0.1.2.5.8.27.27SECTION 405.960
   405.960 Right to a reconsideration.
42:2.0.1.2.5.8.27.28SECTION 405.962
   405.962 Timeframe for filing a request for a reconsideration.
42:2.0.1.2.5.8.27.29SECTION 405.964
   405.964 Place and method of filing a request for a reconsideration.
42:2.0.1.2.5.8.27.30SECTION 405.966
   405.966 Evidence to be submitted with the reconsideration request.
42:2.0.1.2.5.8.27.31SECTION 405.968
   405.968 Conduct of a reconsideration.
42:2.0.1.2.5.8.27.32SECTION 405.970
   405.970 Timeframe for making a reconsideration following a contractor redetermination.
42:2.0.1.2.5.8.27.33SECTION 405.972
   405.972 Withdrawal or dismissal of a request for reconsideration or review of a contractor's dismissal of a request for redetermination.
42:2.0.1.2.5.8.27.34SECTION 405.974
   405.974 Reconsideration and review of a contractor's dismissal of a request for redetermination.
42:2.0.1.2.5.8.27.35SECTION 405.976
   405.976 Notice of a reconsideration.
42:2.0.1.2.5.8.27.36SECTION 405.978
   405.978 Effect of a reconsideration.
42:2.0.1.2.5.8.28SUBJGRP 28
   Reopenings
42:2.0.1.2.5.8.28.37SECTION 405.980
   405.980 Reopening of initial determinations, redeterminations, reconsiderations, decisions, and reviews.
42:2.0.1.2.5.8.28.38SECTION 405.982
   405.982 Notice of a revised determination or decision.
42:2.0.1.2.5.8.28.39SECTION 405.984
   405.984 Effect of a revised determination or decision.
42:2.0.1.2.5.8.28.40SECTION 405.986
   405.986 Good cause for reopening.
42:2.0.1.2.5.8.29SUBJGRP 29
   Expedited Access to Judicial Review
42:2.0.1.2.5.8.29.41SECTION 405.990
   405.990 Expedited access to judicial review.
42:2.0.1.2.5.8.30SUBJGRP 30
   ALJ Hearings
42:2.0.1.2.5.8.30.42SECTION 405.1000
   405.1000 Hearing before an ALJ and decision by an ALJ or attorney adjudicator: General rule.
42:2.0.1.2.5.8.30.43SECTION 405.1002
   405.1002 Right to an ALJ hearing.
42:2.0.1.2.5.8.30.44SECTION 405.1004
   405.1004 Right to a review of QIC notice of dismissal.
42:2.0.1.2.5.8.30.45SECTION 405.1006
   405.1006 Amount in controversy required for an ALJ hearing and judicial review.
42:2.0.1.2.5.8.30.46SECTION 405.1008
   405.1008 Parties to the proceedings on a request for an ALJ hearing.
42:2.0.1.2.5.8.30.47SECTION 405.1010
   405.1010 When CMS or its contractors may participate in the proceedings on a request for an ALJ hearing.
42:2.0.1.2.5.8.30.48SECTION 405.1012
   405.1012 When CMS or its contractors may be a party to a hearing.
42:2.0.1.2.5.8.30.49SECTION 405.1014
   405.1014 Request for an ALJ hearing or a review of a QIC dismissal.
42:2.0.1.2.5.8.30.50SECTION 405.1016
   405.1016 Time frames for deciding an appeal of a QIC reconsideration or escalated request for a QIC reconsideration.
42:2.0.1.2.5.8.30.51SECTION 405.1018
   405.1018 Submitting evidence.
42:2.0.1.2.5.8.30.52SECTION 405.1020
   405.1020 Time and place for a hearing before an ALJ.
42:2.0.1.2.5.8.30.53SECTION 405.1022
   405.1022 Notice of a hearing before an ALJ.
42:2.0.1.2.5.8.30.54SECTION 405.1024
   405.1024 Objections to the issues.
42:2.0.1.2.5.8.30.55SECTION 405.1026
   405.1026 Disqualification of the ALJ or attorney adjudicator.
42:2.0.1.2.5.8.30.56SECTION 405.1028
   405.1028 Review of evidence submitted by parties.
42:2.0.1.2.5.8.30.57SECTION 405.1030
   405.1030 ALJ hearing procedures.
42:2.0.1.2.5.8.30.58SECTION 405.1032
   405.1032 Issues before an ALJ or attorney adjudicator.
42:2.0.1.2.5.8.30.59SECTION 405.1034
   405.1034 Requesting information from the QIC.
42:2.0.1.2.5.8.30.60SECTION 405.1036
   405.1036 Description of an ALJ hearing process.
42:2.0.1.2.5.8.30.61SECTION 405.1037
   405.1037 Discovery.
42:2.0.1.2.5.8.30.62SECTION 405.1038
   405.1038 Deciding a case without a hearing before an ALJ.
42:2.0.1.2.5.8.30.63SECTION 405.1040
   405.1040 Prehearing and posthearing conferences.
42:2.0.1.2.5.8.30.64SECTION 405.1042
   405.1042 The administrative record.
42:2.0.1.2.5.8.30.65SECTION 405.1044
   405.1044 Consolidated proceedings.
42:2.0.1.2.5.8.30.66SECTION 405.1046
   405.1046 Notice of an ALJ or attorney adjudicator decision.
42:2.0.1.2.5.8.30.67SECTION 405.1048
   405.1048 The effect of an ALJ's or attorney adjudicator's decision.
42:2.0.1.2.5.8.30.68SECTION 405.1050
   405.1050 Removal of a hearing request from OMHA to the Council.
42:2.0.1.2.5.8.30.69SECTION 405.1052
   405.1052 Dismissal of a request for a hearing before an ALJ or request for review of a QIC dismissal.
42:2.0.1.2.5.8.30.70SECTION 405.1054
   405.1054 Effect of dismissal of a request for a hearing or request for review of QIC dismissal.
42:2.0.1.2.5.8.30.71SECTION 405.1056
   405.1056 Remands of requests for hearing and requests for review.
42:2.0.1.2.5.8.30.72SECTION 405.1058
   405.1058 Effect of a remand.
42:2.0.1.2.5.8.31SUBJGRP 31
   Applicability of Medicare Coverage Policies
42:2.0.1.2.5.8.31.73SECTION 405.1060
   405.1060 Applicability of national coverage determinations (NCDs).
42:2.0.1.2.5.8.31.74SECTION 405.1062
   405.1062 Applicability of local coverage determinations and other policies not binding on the ALJ or attorney adjudicator and Council.
42:2.0.1.2.5.8.31.75SECTION 405.1063
   405.1063 Applicability of laws, regulations, CMS Rulings, and precedential decisions.
42:2.0.1.2.5.8.32SUBJGRP 32
   Medicare Appeals Council Review
42:2.0.1.2.5.8.32.76SECTION 405.1100
   405.1100 Medicare Appeals Council review: General.
42:2.0.1.2.5.8.32.77SECTION 405.1102
   405.1102 Request for Council review when ALJ or attorney adjudicator issues decision or dismissal.
42:2.0.1.2.5.8.32.78SECTION 405.1106
   405.1106 Where a request for review or escalation may be filed.
42:2.0.1.2.5.8.32.79SECTION 405.1108
   405.1108 Council actions when request for review or escalation is filed.
42:2.0.1.2.5.8.32.80SECTION 405.1110
   405.1110 Council reviews on its own motion.
42:2.0.1.2.5.8.32.81SECTION 405.1112
   405.1112 Content of request for review.
42:2.0.1.2.5.8.32.82SECTION 405.1114
   405.1114 Dismissal of request for review.
42:2.0.1.2.5.8.32.83SECTION 405.1116
   405.1116 Effect of dismissal of request for Council review or request for hearing.
42:2.0.1.2.5.8.32.84SECTION 405.1118
   405.1118 Obtaining evidence from the Council.
42:2.0.1.2.5.8.32.85SECTION 405.1120
   405.1120 Filing briefs with the Council.
42:2.0.1.2.5.8.32.86SECTION 405.1122
   405.1122 What evidence may be submitted to the Council.
42:2.0.1.2.5.8.32.87SECTION 405.1124
   405.1124 Oral argument.
42:2.0.1.2.5.8.32.88SECTION 405.1126
   405.1126 Case remanded by the Council.
42:2.0.1.2.5.8.32.89SECTION 405.1128
   405.1128 Action of the Council.
42:2.0.1.2.5.8.32.90SECTION 405.1130
   405.1130 Effect of the Council's decision.
42:2.0.1.2.5.8.32.91SECTION 405.1132
   405.1132 Request for escalation to Federal court.
42:2.0.1.2.5.8.32.92SECTION 405.1134
   405.1134 Extension of time to file action in Federal district court.
42:2.0.1.2.5.8.32.93SECTION 405.1136
   405.1136 Judicial review.
42:2.0.1.2.5.8.32.94SECTION 405.1138
   405.1138 Case remanded by a Federal district court.
42:2.0.1.2.5.8.32.95SECTION 405.1140
   405.1140 Council review of ALJ decision in a case remanded by a Federal district court.
42:2.0.1.2.5.9SUBPART J
Subpart J - Expedited Determinations and Reconsiderations of Provider Service Terminations, and Procedures for Inpatient Hospital Discharges
42:2.0.1.2.5.9.33.1SECTION 405.1200
   405.1200 Notifying beneficiaries of provider service terminations.
42:2.0.1.2.5.9.33.2SECTION 405.1202
   405.1202 Expedited determination procedures.
42:2.0.1.2.5.9.33.3SECTION 405.1204
   405.1204 Expedited reconsiderations.
42:2.0.1.2.5.9.33.4SECTION 405.1205
   405.1205 Notifying beneficiaries of hospital discharge appeal rights.
42:2.0.1.2.5.9.33.5SECTION 405.1206
   405.1206 Expedited determination procedures for inpatient hospital care.
42:2.0.1.2.5.9.33.6SECTION 405.1208
   405.1208 Hospital requests expedited QIO review.
42:2.0.1.2.5.10SUBPART K
Subparts K-Q [Reserved]
42:2.0.1.2.5.11SUBPART R
Subpart R - Provider Reimbursement Determinations and Appeals
42:2.0.1.2.5.11.33.1SECTION 405.1801
   405.1801 Introduction.
42:2.0.1.2.5.11.33.2SECTION 405.1803
   405.1803 Contractor determination and notice of amount of program reimbursement.
42:2.0.1.2.5.11.33.3SECTION 405.1804
   405.1804 Matters not subject to administrative and judicial review under prospective payment.
42:2.0.1.2.5.11.33.4SECTION 405.1805
   405.1805 Parties to contractor determination.
42:2.0.1.2.5.11.33.5SECTION 405.1807
   405.1807 Effect of contractor determination.
42:2.0.1.2.5.11.33.6SECTION 405.1809
   405.1809 Contractor hearing procedures.
42:2.0.1.2.5.11.33.7SECTION 405.1811
   405.1811 Right to contractor hearing; contents of, and adding issues to, hearing request.
42:2.0.1.2.5.11.33.8SECTION 405.1813
   405.1813 Good cause extension of time limit for requesting a contractor hearing.
42:2.0.1.2.5.11.33.9SECTION 405.1814
   405.1814 Contractor hearing officer jurisdiction.
42:2.0.1.2.5.11.33.10SECTION 405.1815
   405.1815 Parties to proceedings before the contractor hearing officer(s).
42:2.0.1.2.5.11.33.11SECTION 405.1817
   405.1817 Hearing officer or panel of hearing officers authorized to conduct contractor hearing; disqualification of officers.
42:2.0.1.2.5.11.33.12SECTION 405.1819
   405.1819 Conduct of contractor hearing.
42:2.0.1.2.5.11.33.13SECTION 405.1821
   405.1821 Prehearing discovery and other proceedings prior to the contractor hearing.
42:2.0.1.2.5.11.33.14SECTION 405.1823
   405.1823 Evidence at contractor hearing.
42:2.0.1.2.5.11.33.15SECTION 405.1825
   405.1825 Witnesses at contractor hearing.
42:2.0.1.2.5.11.33.16SECTION 405.1827
   405.1827 Record of proceedings before the contractor hearing officer(s).
42:2.0.1.2.5.11.33.17SECTION 405.1829
   405.1829 Scope of authority of contractor hearing officer(s).
42:2.0.1.2.5.11.33.18SECTION 405.1831
   405.1831 Contractor hearing decision.
42:2.0.1.2.5.11.33.19SECTION 405.1832
   405.1832 Contractor hearing officer review of compliance with the substantive reimbursement requirement of an appropriate cost report claim.
42:2.0.1.2.5.11.33.20SECTION 405.1833
   405.1833 Effect of contractor hearing decision.
42:2.0.1.2.5.11.33.21SECTION 405.1834
   405.1834 CMS reviewing official procedure.
42:2.0.1.2.5.11.33.22SECTION 405.1835
   405.1835 Right to Board hearing; contents of, and adding issues to, hearing request.
42:2.0.1.2.5.11.33.23SECTION 405.1836
   405.1836 Good cause extension of time limit for requesting a Board hearing.
42:2.0.1.2.5.11.33.24SECTION 405.1837
   405.1837 Group appeals.
42:2.0.1.2.5.11.33.25SECTION 405.1839
   405.1839 Amount in controversy.
42:2.0.1.2.5.11.33.26SECTION 405.1840
   405.1840 Board jurisdiction.
42:2.0.1.2.5.11.33.27SECTION 405.1842
   405.1842 Expedited judicial review.
42:2.0.1.2.5.11.33.28SECTION 405.1843
   405.1843 Parties to proceedings in a Board appeal.
42:2.0.1.2.5.11.33.29SECTION 405.1845
   405.1845 Composition of Board; hearings, decisions, and remands.
42:2.0.1.2.5.11.33.30SECTION 405.1847
   405.1847 Disqualification of Board members.
42:2.0.1.2.5.11.33.31SECTION 405.1849
   405.1849 Establishment of time and place of hearing by the Board.
42:2.0.1.2.5.11.33.32SECTION 405.1851
   405.1851 Conduct of Board hearing.
42:2.0.1.2.5.11.33.33SECTION 405.1853
   405.1853 Board proceedings prior to any hearing; discovery.
42:2.0.1.2.5.11.33.34SECTION 405.1855
   405.1855 Evidence at Board hearing.
42:2.0.1.2.5.11.33.35SECTION 405.1857
   405.1857 Subpoenas.
42:2.0.1.2.5.11.33.36SECTION 405.1859
   405.1859 Witnesses.
42:2.0.1.2.5.11.33.37SECTION 405.1861
   405.1861 Oral argument and written allegations.
42:2.0.1.2.5.11.33.38SECTION 405.1863
   405.1863 Administrative policy at issue.
42:2.0.1.2.5.11.33.39SECTION 405.1865
   405.1865 Record of administrative proceedings.
42:2.0.1.2.5.11.33.40SECTION 405.1867
   405.1867 Scope of Board's legal authority.
42:2.0.1.2.5.11.33.41SECTION 405.1868
   405.1868 Board actions in response to failure to follow Board rules.
42:2.0.1.2.5.11.33.42SECTION 405.1869
   405.1869 Scope of Board's authority in a hearing decision.
42:2.0.1.2.5.11.33.43SECTION 405.1871
   405.1871 Board hearing decision.
42:2.0.1.2.5.11.33.44SECTION 405.1873
   405.1873 Board review of compliance with the reimbursement requirement of an appropriate cost report claim.
42:2.0.1.2.5.11.33.45SECTION 405.1875
   405.1875 Administrator review.
42:2.0.1.2.5.11.33.46SECTION 405.1877
   405.1877 Judicial review.
42:2.0.1.2.5.11.33.47SECTION 405.1881
   405.1881 Appointment of representative.
42:2.0.1.2.5.11.33.48SECTION 405.1883
   405.1883 Authority of representative.
42:2.0.1.2.5.11.33.49SECTION 405.1885
   405.1885 Reopening a contractor determination or reviewing entity decision.
42:2.0.1.2.5.11.33.50SECTION 405.1887
   405.1887 Notice of reopening; effect of reopening.
42:2.0.1.2.5.11.33.51SECTION 405.1889
   405.1889 Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.
42:2.0.1.2.5.12SUBPART S
Subparts S-T [Reserved]
42:2.0.1.2.5.13SUBPART U
Subpart U - Conditions for Coverage of Suppliers of End-Stage Renal Disease (ESRD) Services
42:2.0.1.2.5.13.33.1SECTION 405.2100-405.2101
   405.2100-405.2101 [Reserved]
42:2.0.1.2.5.13.33.2SECTION 405.2102
   405.2102 Definitions.
42:2.0.1.2.5.13.33.3SECTION 405.2110
   405.2110 Designation of ESRD networks.
42:2.0.1.2.5.13.33.4SECTION 405.2111
   405.2111 [Reserved]
42:2.0.1.2.5.13.33.5SECTION 405.2112
   405.2112 ESRD network organizations.
42:2.0.1.2.5.13.33.6SECTION 405.2113
   405.2113 Medical review board.
42:2.0.1.2.5.13.33.7SECTION 405.2114
   405.2114 [Reserved]
42:2.0.1.2.5.13.33.8SECTION 405.2131-405.2184
   405.2131-405.2184 [Reserved]
42:2.0.1.2.5.14SUBPART V
Subparts V-W [Reserved]
42:2.0.1.2.5.15SUBPART X
Subpart X - Rural Health Clinic and Federally Qualified Health Center Services
42:2.0.1.2.5.15.33SUBJGRP 33
   Federally Qualified Health Center Services
42:2.0.1.2.5.15.33.1SECTION 405.2400
   405.2400 Basis.
42:2.0.1.2.5.15.33.2SECTION 405.2401
   405.2401 Scope and definitions.
42:2.0.1.2.5.15.33.3SECTION 405.2402
   405.2402 Rural health clinic basic requirements.
42:2.0.1.2.5.15.33.4SECTION 405.2403
   405.2403 Rural health clinic content and terms of the agreement with the Secretary.
42:2.0.1.2.5.15.33.5SECTION 405.2404
   405.2404 Termination of rural health clinic agreements.
42:2.0.1.2.5.15.33.6SECTION 405.2410
   405.2410 Application of Part B deductible and coinsurance.
42:2.0.1.2.5.15.33.7SECTION 405.2411
   405.2411 Scope of benefits.
42:2.0.1.2.5.15.33.8SECTION 405.2412
   405.2412 Physicians' services.
42:2.0.1.2.5.15.33.9SECTION 405.2413
   405.2413 Services and supplies incident to a physician's services.
42:2.0.1.2.5.15.33.10SECTION 405.2414
   405.2414 Nurse practitioner, physician assistant, and certified nurse midwife services.
42:2.0.1.2.5.15.33.11SECTION 405.2415
   405.2415 Incident to services and direct supervision.
42:2.0.1.2.5.15.33.12SECTION 405.2416
   405.2416 Visiting nurse services.
42:2.0.1.2.5.15.33.13SECTION 405.2417
   405.2417 Visiting nurse services: Determination of shortage of agencies.
42:2.0.1.2.5.15.33.14SECTION 405.2430
   405.2430 Basic requirements.
42:2.0.1.2.5.15.33.15SECTION 405.2434
   405.2434 Content and terms of the agreement.
42:2.0.1.2.5.15.33.16SECTION 405.2436
   405.2436 Termination of agreement.
42:2.0.1.2.5.15.33.17SECTION 405.2440
   405.2440 Conditions for reinstatement after termination by CMS.
42:2.0.1.2.5.15.33.18SECTION 405.2442
   405.2442 Notice to the public.
42:2.0.1.2.5.15.33.19SECTION 405.2444
   405.2444 Change of ownership.
42:2.0.1.2.5.15.33.20SECTION 405.2446
   405.2446 Scope of services.
42:2.0.1.2.5.15.33.21SECTION 405.2448
   405.2448 Preventive primary services.
42:2.0.1.2.5.15.33.22SECTION 405.2449
   405.2449 Preventive services.
42:2.0.1.2.5.15.33.23SECTION 405.2450
   405.2450 Clinical psychologist and clinical social worker services.
42:2.0.1.2.5.15.33.24SECTION 405.2452
   405.2452 Services and supplies incident to clinical psychologist and clinical social worker services.
42:2.0.1.2.5.15.34SUBJGRP 34
   Payment for Rural Health Clinic and Federally Qualified Health Center Services
42:2.0.1.2.5.15.34.25SECTION 405.2460
   405.2460 Applicability of general payment exclusions.
42:2.0.1.2.5.15.34.26SECTION 405.2462
   405.2462 Payment for RHC and FQHC services.
42:2.0.1.2.5.15.34.27SECTION 405.2463
   405.2463 What constitutes a visit.
42:2.0.1.2.5.15.34.28SECTION 405.2464
   405.2464 Payment rate.
42:2.0.1.2.5.15.34.29SECTION 405.2466
   405.2466 Annual reconciliation.
42:2.0.1.2.5.15.34.30SECTION 405.2467
   405.2467 Requirements of the FQHC PPS.
42:2.0.1.2.5.15.34.31SECTION 405.2468
   405.2468 Allowable costs.
42:2.0.1.2.5.15.34.32SECTION 405.2469
   405.2469 FQHC supplemental payments.
42:2.0.1.2.5.15.34.33SECTION 405.2470
   405.2470 Reports and maintenance of records.
42:2.0.1.2.5.15.34.34SECTION 405.2472
   405.2472 Beneficiary appeals.