Title 42

SECTION 425.800

425.800 Preclusion of administrative and judicial review.

§ 425.800 Preclusion of administrative and judicial review.

(a) There is no reconsideration, appeal, or other administrative or judicial review of the following determinations under this part:

(1) The specification of quality and performance standards under §§ 425.500, 425.502, 425.510, and 425.512.

(2) The assessment of the quality of care furnished by an ACO under the performance standards established in § 425.502 or § 425.512, as applicable.

(3) The assignment of Medicare fee-for-service beneficiaries under Subpart E of this part.

(4) The initial determination or revised initial determination of whether an ACO is eligible for shared savings, and the amount of such shared savings, including the initial determination or revised initial determination of the estimated average per capita Medicare expenditures under the ACO for Medicare fee-for-service beneficiaries assigned to the ACO and the average benchmark for the ACO in accordance with section 1899(d) of the Act, as implemented under §§ 425.601, 425.602, 425.603, 425.604, 425.605, 425.606, and 425.610.

(5) The percent of shared savings specified by the Secretary and the limit on the total amount of shared savings established under §§ 425.604, 425.605, 425.606, and 425.610.

(6) The termination of an ACO for failure to meet the quality performance standards established under § 425.502 or § 425.512, as applicable.

(7) The termination of a beneficiary incentive program established under § 425.304(c).

(b) [Reserved]

[76 FR 67973, Nov. 2, 2011, as amended at 81 FR 38017, June 10, 2016; 83 FR 68082, Dec. 31, 2018; 85 FR 85044, Dec. 28, 2020]

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