Reopening of Contract Determination or Decision of a Hearing

40 - Reopening of Contract Determination or Decision of a Hearing Officer or the CMS Administrator (Rev. 122, Issued: 05-27-16, Effective: 06-28-16, Implementation: 06-28-16) A reopening is not an appeal right. It is an administrative procedure that permits reexamination of an existing determination for a specific reason. If an applicant or MAO believes it has a basis for a decision to be reopened, it may request that the decision- maker reopen the matter. The decision whether to act on such a request, however, is committed to the decision-maker’s discretion, and is not subject to appeal or further review of any kind. This policy is consistent with our general policies on reopening decisions, as discussed in 42 CFR Part 405, Subpart R, Provider Reimbursement Determinations and Appeals. The notice of reopening and any revisions following the reopening is mailed to the parties and specifies the reasons for revisions.