Medicare Managed Care Manual (Pub. 100-16), Ch. 14 § 20
Hearings
20 - Hearings
(Rev. 122, Issued: 05-27-16, Effective: 06-28-16, Implementation: 06-28-16)
A hearing is the method by which MAOs appeal an unfavorable contract determination.
The following parties are entitled to a hearing:
•
An applicant that has been determined to be unqualified to enter into a
contract with CMS; and
•
An MAO whose contract with CMS has been terminated or has not been
renewed; and
•
An applicant that has been determined to be unqualified to offer a SNP.
During a hearing to review a contract determination, the applicant has the burden of
proving by a preponderance of the evidence that CMS’s determination was inconsistent
with established regulatory requirements.