Title 42

PART 498

Part 498 - Appeals Procedures For Determinations That Affect Participation In The Medicare Program And For Determinations That Affect The Participation Of Icfs/iid And Certain Nfs In The Medicaid Program

PART 498 - APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT PARTICIPATION IN THE MEDICARE PROGRAM AND FOR DETERMINATIONS THAT AFFECT THE PARTICIPATION OF ICFs/IID AND CERTAIN NFs IN THE MEDICAID PROGRAM Authority:42 U.S.C. 1302, 1320a-7j, and 1395hh. Source:52 FR 22446, June 12, 1987, unless otherwise noted.

42:5.0.1.1.12.1SUBPART A
Subpart A - General Provisions
42:5.0.1.1.12.1.41.1SECTION 498.1
   498.1 Statutory basis.
42:5.0.1.1.12.1.41.2SECTION 498.2
   498.2 Definitions.
42:5.0.1.1.12.1.41.3SECTION 498.3
   498.3 Scope and applicability.
42:5.0.1.1.12.1.41.4SECTION 498.4
   498.4 NFs subject to appeals process in part 498.
42:5.0.1.1.12.1.41.5SECTION 498.5
   498.5 Appeal rights.
42:5.0.1.1.12.1.41.6SECTION 498.10
   498.10 Appointment of representatives.
42:5.0.1.1.12.1.41.7SECTION 498.11
   498.11 Authority of representatives.
42:5.0.1.1.12.1.41.8SECTION 498.13
   498.13 Fees for services of representatives.
42:5.0.1.1.12.1.41.9SECTION 498.15
   498.15 Charge for transcripts.
42:5.0.1.1.12.1.41.10SECTION 498.17
   498.17 Filing of briefs with the ALJ or Departmental Appeals Board, and opportunity for rebuttal.
42:5.0.1.1.12.2SUBPART B
Subpart B - Initial, Reconsidered, and Revised Determinations
42:5.0.1.1.12.2.41.1SECTION 498.20
   498.20 Notice and effect of initial determinations.
42:5.0.1.1.12.2.41.2SECTION 498.22
   498.22 Reconsideration.
42:5.0.1.1.12.2.41.3SECTION 498.23
   498.23 Withdrawal of request for reconsideration.
42:5.0.1.1.12.2.41.4SECTION 498.24
   498.24 Reconsidered determination.
42:5.0.1.1.12.2.41.5SECTION 498.25
   498.25 Notice and effect of reconsidered determination.
42:5.0.1.1.12.3SUBPART C
Subpart C - Reopening of Initial or Reconsidered Determinations
42:5.0.1.1.12.3.41.1SECTION 498.30
   498.30 Limitation on reopening.
42:5.0.1.1.12.3.41.2SECTION 498.32
   498.32 Notice and effect of reopening and revision.
42:5.0.1.1.12.4SUBPART D
Subpart D - Hearings
42:5.0.1.1.12.4.41.1SECTION 498.40
   498.40 Request for hearing.
42:5.0.1.1.12.4.41.2SECTION 498.42
   498.42 Parties to the hearing.
42:5.0.1.1.12.4.41.3SECTION 498.44
   498.44 Designation of hearing official.
42:5.0.1.1.12.4.41.4SECTION 498.45
   498.45 Disqualification of Administrative Law Judge.
42:5.0.1.1.12.4.41.5SECTION 498.47
   498.47 Prehearing conference.
42:5.0.1.1.12.4.41.6SECTION 498.48
   498.48 Notice of prehearing conference.
42:5.0.1.1.12.4.41.7SECTION 498.49
   498.49 Conduct of prehearing conference.
42:5.0.1.1.12.4.41.8SECTION 498.50
   498.50 Record, order, and effect of prehearing conference.
42:5.0.1.1.12.4.41.9SECTION 498.52
   498.52 Time and place of hearing.
42:5.0.1.1.12.4.41.10SECTION 498.53
   498.53 Change in time and place of hearing.
42:5.0.1.1.12.4.41.11SECTION 498.54
   498.54 Joint hearings.
42:5.0.1.1.12.4.41.12SECTION 498.56
   498.56 Hearing on new issues.
42:5.0.1.1.12.4.41.13SECTION 498.58
   498.58 Subpoenas.
42:5.0.1.1.12.4.41.14SECTION 498.60
   498.60 Conduct of hearing.
42:5.0.1.1.12.4.41.15SECTION 498.61
   498.61 Evidence.
42:5.0.1.1.12.4.41.16SECTION 498.62
   498.62 Witnesses.
42:5.0.1.1.12.4.41.17SECTION 498.63
   498.63 Oral and written summation.
42:5.0.1.1.12.4.41.18SECTION 498.64
   498.64 Record of hearing.
42:5.0.1.1.12.4.41.19SECTION 498.66
   498.66 Waiver of right to appear and present evidence.
42:5.0.1.1.12.4.41.20SECTION 498.68
   498.68 Dismissal of request for hearing.
42:5.0.1.1.12.4.41.21SECTION 498.69
   498.69 Dismissal for abandonment.
42:5.0.1.1.12.4.41.22SECTION 498.70
   498.70 Dismissal for cause.
42:5.0.1.1.12.4.41.23SECTION 498.71
   498.71 Notice and effect of dismissal and right to request review.
42:5.0.1.1.12.4.41.24SECTION 498.72
   498.72 Vacating a dismissal of request for hearing.
42:5.0.1.1.12.4.41.25SECTION 498.74
   498.74 Administrative Law Judge's decision.
42:5.0.1.1.12.4.41.26SECTION 498.76
   498.76 Removal of hearing to Departmental Appeals Board.
42:5.0.1.1.12.4.41.27SECTION 498.78
   498.78 Remand by the Administrative Law Judge.
42:5.0.1.1.12.4.41.28SECTION 498.79
   498.79 Timeframes for deciding an enrollment appeal before an ALJ.
42:5.0.1.1.12.5SUBPART E
Subpart E - Departmental Appeals Board Review
42:5.0.1.1.12.5.41.1SECTION 498.80
   498.80 Right to request Departmental Appeals Board review of Administrative Law Judge's decision or dismissal.
42:5.0.1.1.12.5.41.2SECTION 498.82
   498.82 Request for Departmental Appeals Board review.
42:5.0.1.1.12.5.41.3SECTION 498.83
   498.83 Departmental Appeals Board action on request for review.
42:5.0.1.1.12.5.41.4SECTION 498.85
   498.85 Procedures before the Departmental Appeals Board on review.
42:5.0.1.1.12.5.41.5SECTION 498.86
   498.86 Evidence admissible on review.
42:5.0.1.1.12.5.41.6SECTION 498.88
   498.88 Decision or remand by the Departmental Appeals Board.
42:5.0.1.1.12.5.41.7SECTION 498.90
   498.90 Effect of Departmental Appeals Board decision.
42:5.0.1.1.12.5.41.8SECTION 498.95
   498.95 Extension of time for seeking judicial review.
42:5.0.1.1.12.6SUBPART F
Subpart F - Reopening of Decisions Made by Administrative Law Judges or the Departmental Appeals Board
42:5.0.1.1.12.6.41.1SECTION 498.100
   498.100 Basis, timing, and authority for reopening an ALJ or Board decision.
42:5.0.1.1.12.6.41.2SECTION 498.102
   498.102 Revision of reopened decision.
42:5.0.1.1.12.6.41.3SECTION 498.103
   498.103 Notice and effect of revised decision.