Recommending Agency Referral of OMHA Decisions or Dismissals

340.1 - Recommending Agency Referral of OMHA Decisions or Dismissals (Rev. 4278., Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19) CMS may refer a case to the Appeals Council for it to consider under its own motion review authority within 60 days after the date of the ALJ hearing or attorney adjudicator decision or dismissal. This is known as an “agency referral”. The Appeals Council may adopt, modify, or reverse OMHA’s decision, may remand the case to an ALJ or attorney adjudicator for further proceedings, or may dismiss an agency referral request. For OMHA decisions issued by OMHA ALJs and attorney adjudicators, the AdQIC will be responsible for reviewing ALJ and attorney adjudicator decisions and determining whether an agency referral is appropriate. During the effectuation of an ALJ or attorney adjudicator decision, if the MAC’s medical director disagrees with the decision and wishes to discuss the decision for potential referral to the Appeals Council, the medical director shall contact the AdQIC.