Initial Determinations Versus Administrative Actions - Right to

3050 - Initial Determinations Versus Administrative Actions - Right to Review (Rev. 1, 05-21-04) Only initial determinations are subject to reconsideration, hearing, or appeal. In general, an initial determination is a decision with respect to the following matters: • Whether a provider or prospective provider meets or does not meet the Medicare requirements as a provider of services; • Whether a supplier or prospective supplier meets or does not meet the appropriate Conditions for Coverage of its services; • Whether the termination of a provider agreement or benefits agreement is in accordance with 42 CFR 489.53, the termination of a RHC agreement is in accordance with 42 CFR 405.2404, the termination of a FQHC agreement is in accordance with 42 CFR 405.2442, or the termination of an ASC is in accordance with 42 CFR 416.35; • Whether a hospital meets or does not meet or continues to meet the requirements to qualify as an emergency services hospital; • Whether the services of a supplier meet or continue to meet the Conditions for Coverage; or • The effective date of the provider agreement between CMS and a provider of services, or the effective date CMS approved for a supplier of services.