Title 42

SECTION 478.28

478.28 Qualifications of a reconsideration reviewer.

§ 478.28 Qualifications of a reconsideration reviewer.

A reconsideration reviewer must be someone who is -

(a) Qualified under § 476.98 of this chapter to make an initial determination.

(b) Not the individual who made the initial denial determination.

(c) A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review.

[50 FR 15330, Apr. 17, 1985, as amended at 77 FR 68563, Nov. 15, 2012]

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