Title 42

PART 405 SUBPART R

Subpart R - Provider Reimbursement Determinations and Appeals Authority:Secs. 205, 1102, 1814(b), 1815(a), 1833, 1861(v), 1871, 1872, 1878, and 1886 of the Social Security Act (42 U.S.C. 405, 1302, 1395f(b), 1395g(a), 1395l, 1395x(v), 1395hh, 1395ii, 1395oo, and 1395ww). Source:39 FR 34515, Sept. 26, 1974, unless otherwise noted. Redesignated at 42 FR 52826, Sept. 30, 1977. Editorial Note:Nomenclature changes to subpart R of part 405 appear at 79 FR 55031, Aug. 22, 2014.

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

42:2.0.1.2.6.12.33.1	SECTION 405.1801	405.1801 Introduction.
42:2.0.1.2.6.12.33.2	SECTION 405.1803	405.1803 Contractor determination and notice of amount of program reimbursement.
42:2.0.1.2.6.12.33.3	SECTION 405.1804	405.1804 Matters not subject to administrative and judicial review under prospective payment.
42:2.0.1.2.6.12.33.4	SECTION 405.1805	405.1805 Parties to contractor determination.
42:2.0.1.2.6.12.33.5	SECTION 405.1807	405.1807 Effect of contractor determination.
42:2.0.1.2.6.12.33.6	SECTION 405.1809	405.1809 Contractor hearing procedures.
42:2.0.1.2.6.12.33.7	SECTION 405.1811	405.1811 Right to contractor hearing; contents of, and adding issues to, hearing request.
42:2.0.1.2.6.12.33.8	SECTION 405.1813	405.1813 Good cause extension of time limit for requesting a contractor hearing.
42:2.0.1.2.6.12.33.9	SECTION 405.1814	405.1814 Contractor hearing officer jurisdiction.
42:2.0.1.2.6.12.33.10	SECTION 405.1815	405.1815 Parties to proceedings before the contractor hearing officer(s).
42:2.0.1.2.6.12.33.11	SECTION 405.1817	405.1817 Hearing officer or panel of hearing officers authorized to conduct contractor hearing; disqualification of officers.
42:2.0.1.2.6.12.33.12	SECTION 405.1819	405.1819 Conduct of contractor hearing.
42:2.0.1.2.6.12.33.13	SECTION 405.1821	405.1821 Prehearing discovery and other proceedings prior to the contractor hearing.
42:2.0.1.2.6.12.33.14	SECTION 405.1823	405.1823 Evidence at contractor hearing.
42:2.0.1.2.6.12.33.15	SECTION 405.1825	405.1825 Witnesses at contractor hearing.
42:2.0.1.2.6.12.33.16	SECTION 405.1827	405.1827 Record of proceedings before the contractor hearing officer(s).
42:2.0.1.2.6.12.33.17	SECTION 405.1829	405.1829 Scope of authority of contractor hearing officer(s).
42:2.0.1.2.6.12.33.18	SECTION 405.1831	405.1831 Contractor hearing decision.
42:2.0.1.2.6.12.33.19	SECTION 405.1832	405.1832 Contractor hearing officer review of compliance with the substantive reimbursement requirement of an appropriate cost report claim.
42:2.0.1.2.6.12.33.20	SECTION 405.1833	405.1833 Effect of contractor hearing decision.
42:2.0.1.2.6.12.33.21	SECTION 405.1834	405.1834 CMS reviewing official procedure.
42:2.0.1.2.6.12.33.22	SECTION 405.1835	405.1835 Right to Board hearing; contents of, and adding issues to, hearing request.
42:2.0.1.2.6.12.33.23	SECTION 405.1836	405.1836 Good cause extension of time limit for requesting a Board hearing.
42:2.0.1.2.6.12.33.24	SECTION 405.1837	405.1837 Group appeals.
42:2.0.1.2.6.12.33.25	SECTION 405.1839	405.1839 Amount in controversy.
42:2.0.1.2.6.12.33.26	SECTION 405.1840	405.1840 Board jurisdiction.
42:2.0.1.2.6.12.33.27	SECTION 405.1842	405.1842 Expedited judicial review.
42:2.0.1.2.6.12.33.28	SECTION 405.1843	405.1843 Parties to proceedings in a Board appeal.
42:2.0.1.2.6.12.33.29	SECTION 405.1845	405.1845 Composition of Board; hearings, decisions, and remands.
42:2.0.1.2.6.12.33.30	SECTION 405.1847	405.1847 Disqualification of Board members.
42:2.0.1.2.6.12.33.31	SECTION 405.1849	405.1849 Establishment of time and place of hearing by the Board.
42:2.0.1.2.6.12.33.32	SECTION 405.1851	405.1851 Conduct of Board hearing.
42:2.0.1.2.6.12.33.33	SECTION 405.1853	405.1853 Board proceedings prior to any hearing; discovery.
42:2.0.1.2.6.12.33.34	SECTION 405.1855	405.1855 Evidence at Board hearing.
42:2.0.1.2.6.12.33.35	SECTION 405.1857	405.1857 Subpoenas.
42:2.0.1.2.6.12.33.36	SECTION 405.1859	405.1859 Witnesses.
42:2.0.1.2.6.12.33.37	SECTION 405.1861	405.1861 Oral argument and written allegations.
42:2.0.1.2.6.12.33.38	SECTION 405.1863	405.1863 Administrative policy at issue.
42:2.0.1.2.6.12.33.39	SECTION 405.1865	405.1865 Record of administrative proceedings.
42:2.0.1.2.6.12.33.40	SECTION 405.1867	405.1867 Scope of Board's legal authority.
42:2.0.1.2.6.12.33.41	SECTION 405.1868	405.1868 Board actions in response to failure to follow Board rules.
42:2.0.1.2.6.12.33.42	SECTION 405.1869	405.1869 Scope of Board's authority in a hearing decision.
42:2.0.1.2.6.12.33.43	SECTION 405.1871	405.1871 Board hearing decision.
42:2.0.1.2.6.12.33.44	SECTION 405.1873	405.1873 Board review of compliance with the reimbursement requirement of an appropriate cost report claim.
42:2.0.1.2.6.12.33.45	SECTION 405.1875	405.1875 Administrator review.
42:2.0.1.2.6.12.33.46	SECTION 405.1877	405.1877 Judicial review.
42:2.0.1.2.6.12.33.47	SECTION 405.1881	405.1881 Appointment of representative.
42:2.0.1.2.6.12.33.48	SECTION 405.1883	405.1883 Authority of representative.
42:2.0.1.2.6.12.33.49	SECTION 405.1885	405.1885 Reopening a contractor determination or reviewing entity decision.
42:2.0.1.2.6.12.33.50	SECTION 405.1887	405.1887 Notice of reopening; effect of reopening.
42:2.0.1.2.6.12.33.51	SECTION 405.1889	405.1889 Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

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