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. | |