Nature of Reconsideration Determination - SA Procedures

3052 - Nature of Reconsideration Determination - SA Procedures (Rev. 1, 05-21-04) 3052A - Right to Reconsideration of Initial Denial (Rev. 1, 05-21-04) Reconsideration is granted administratively, not statutorily, pursuant to regulations 42 CFR 498.22 through 498.25. Any prospective provider or supplier dissatisfied with an initial determination that does not qualify as a Medicare provider may submit a request that the Secretary reconsider the decision within 60 calendar days from receipt of the notice of initial determination. Reconsideration is a review of the determination. This review results in affirmation or reversal or the determination. Further appeal rights include hearing before an ALJ and review by the DAB. 3052B - Request for Reconsideration (Rev. 1, 05-21-04) A request for reconsideration is any written expression of dissatisfaction with the initial decision. The request may be in the form of a letter or statement that explains the issues, or the findings of fact with which the affected party disagrees, and the reasons for the disagreement. The reconsideration request may be signed by any responsible official of the provider or by an attorney on behalf of the provider. The SA officially dates or date- stamps any request the day of receipt in the SA. 3052C - Acknowledgment of Reconsideration Request (Rev. 1, 05-21-04) The SA acknowledges the request promptly and forwards a copy of the request and acknowledgment letter to the RO immediately. The RO will advise if additional development is required. Also, the SA forwards any subsequent information received that would affect the reconsideration or hearing. If an attorney files the request, the SA sends a copy of the acknowledgment to the provider. Most cases require SA redevelopment, particularly if there are questions about the provider’s efforts and plans to correct previously cited deficiencies. If requesting additional evidence from the entity, stipulate in the acknowledgment a reasonable deadline for submittal. 3052D - Documentation of File (Rev. 1, 05-21-04) A reconsideration review is not complete unless the file contains adequate documentation to fully explain every statutory deficiency and finding of noncompliance with program requirements. The SA sends the RO all reports of on-site visits and telephone contacts with the provider, as well as any pertinent information available form the licensing agency.