Federal (United States) · Regulations
Subpart I — Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)
103 sections
103 sections
- 42 C.F.R. § 405.900Basis and scope.
- 42 C.F.R. § 405.902Definitions.
- 42 C.F.R. § 405.903Prepayment review.
- 42 C.F.R. § 405.904Medicare initial determinations, redeterminations and appeals: General description.
- 42 C.F.R. § 405.906Parties to the initial determinations, redeterminations, reconsiderations, hearings, and reviews.
- 42 C.F.R. § 405.908Medicaid State agencies.
- 42 C.F.R. § 405.910Appointed representatives.
- 42 C.F.R. § 405.912Assignment of appeal rights.
- 42 C.F.R. § 405.920Initial determinations.
- 42 C.F.R. § 405.921Notice of initial determination.
- 42 C.F.R. § 405.922Time frame for processing initial determinations.
- 42 C.F.R. § 405.924Actions that are initial determinations.
- 42 C.F.R. § 405.925Decisions of utilization review committees.
- 42 C.F.R. § 405.926Actions that are not initial determinations.
- 42 C.F.R. § 405.927Initial determinations subject to the reopenings process.
- 42 C.F.R. § 405.928Effect of the initial determination.
- 42 C.F.R. § 405.929Post-payment review.
- 42 C.F.R. § 405.930Failure to respond to additional documentation request.
- 42 C.F.R. § 405.931Scope, basis, and definitions.
- 42 C.F.R. § 405.932Right to appeal a denial of Part A coverage resulting from a change in patient status.
- 42 C.F.R. § 405.934Reconsideration.
- 42 C.F.R. § 405.936Hearings before an ALJ and decisions by an ALJ or Attorney Adjudicator.
- 42 C.F.R. § 405.938Review by the Medicare Appeals Council and judicial review.
- 42 C.F.R. § 405.940Right to a redetermination.
- 42 C.F.R. § 405.942Time frame for filing a request for a redetermination.
- 42 C.F.R. § 405.944Place and method of filing a request for a redetermination.
- 42 C.F.R. § 405.946Evidence to be submitted with the redetermination request.
- 42 C.F.R. § 405.947Notice to the beneficiary of applicable plan's request for a redetermination.
- 42 C.F.R. § 405.948Conduct of a redetermination.
- 42 C.F.R. § 405.950Time frame for making a redetermination.
- 42 C.F.R. § 405.952Withdrawal or dismissal of a request for a redetermination.
- 42 C.F.R. § 405.954Redetermination.
- 42 C.F.R. § 405.956Notice of a redetermination.
- 42 C.F.R. § 405.958Effect of a redetermination.
- 42 C.F.R. § 405.960Right to a reconsideration.
- 42 C.F.R. § 405.962Timeframe for filing a request for a reconsideration.
- 42 C.F.R. § 405.964Place and method of filing a request for a reconsideration.
- 42 C.F.R. § 405.966Evidence to be submitted with the reconsideration request.
- 42 C.F.R. § 405.968Conduct of a reconsideration.
- 42 C.F.R. § 405.970Timeframe for making a reconsideration following a contractor redetermination.
- 42 C.F.R. § 405.972Withdrawal or dismissal of a request for reconsideration or review of a contractor's dismissal of a request for redetermination.
- 42 C.F.R. § 405.974Reconsideration and review of a contractor's dismissal of a request for redetermination.
- 42 C.F.R. § 405.976Notice of a reconsideration.
- 42 C.F.R. § 405.978Effect of a reconsideration.
- 42 C.F.R. § 405.980Reopening of initial determinations, redeterminations, reconsiderations, decisions, and reviews.
- 42 C.F.R. § 405.982Notice of a revised determination or decision.
- 42 C.F.R. § 405.984Effect of a revised determination or decision.
- 42 C.F.R. § 405.986Good cause for reopening.
- 42 C.F.R. § 405.990Expedited access to judicial review.
- 42 C.F.R. § 405.1000Hearing before an ALJ and decision by an ALJ or attorney adjudicator: General rule.
- 42 C.F.R. § 405.1002Right to an ALJ hearing.
- 42 C.F.R. § 405.1004Right to a review of QIC notice of dismissal.
- 42 C.F.R. § 405.1006Amount in controversy required for an ALJ hearing and judicial review.
- 42 C.F.R. § 405.1008Parties to the proceedings on a request for an ALJ hearing.
- 42 C.F.R. § 405.1010When CMS or its contractors may participate in the proceedings on a request for an ALJ hearing.
- 42 C.F.R. § 405.1012When CMS or its contractors may be a party to a hearing.
- 42 C.F.R. § 405.1014Request for an ALJ hearing or a review of a QIC dismissal.
- 42 C.F.R. § 405.1016Time frames for deciding an appeal of a QIC reconsideration or escalated request for a QIC reconsideration.
- 42 C.F.R. § 405.1018Submitting evidence.
- 42 C.F.R. § 405.1020Time and place for a hearing before an ALJ.
- 42 C.F.R. § 405.1022Notice of a hearing before an ALJ.
- 42 C.F.R. § 405.1024Objections to the issues.
- 42 C.F.R. § 405.1026Disqualification of the ALJ or attorney adjudicator.
- 42 C.F.R. § 405.1028Review of evidence submitted by parties.
- 42 C.F.R. § 405.1030ALJ hearing procedures.
- 42 C.F.R. § 405.1032Issues before an ALJ or attorney adjudicator.
- 42 C.F.R. § 405.1034Requesting information from the QIC.
- 42 C.F.R. § 405.1036Description of an ALJ hearing process.
- 42 C.F.R. § 405.1037Discovery.
- 42 C.F.R. § 405.1038Deciding a case without a hearing before an ALJ.
- 42 C.F.R. § 405.1040Prehearing and posthearing conferences.
- 42 C.F.R. § 405.1042The administrative record.
- 42 C.F.R. § 405.1044Consolidated proceedings.
- 42 C.F.R. § 405.1046Notice of an ALJ or attorney adjudicator decision.
- 42 C.F.R. § 405.1048The effect of an ALJ's or attorney adjudicator's decision.
- 42 C.F.R. § 405.1050Removal of a hearing request from OMHA to the Council.
- 42 C.F.R. § 405.1052Dismissal of a request for a hearing before an ALJ or request for review of a QIC dismissal.
- 42 C.F.R. § 405.1054Effect of dismissal of a request for a hearing or request for review of QIC dismissal.
- 42 C.F.R. § 405.1056Remands of requests for hearing and requests for review.
- 42 C.F.R. § 405.1058Effect of a remand.
- 42 C.F.R. § 405.1060Applicability of national coverage determinations (NCDs).
- 42 C.F.R. § 405.1062Applicability of local coverage determinations and other policies not binding on the ALJ or attorney adjudicator and Council.
- 42 C.F.R. § 405.1063Applicability of laws, regulations, CMS Rulings, and precedential decisions.
- 42 C.F.R. § 405.1100Medicare Appeals Council review: General.
- 42 C.F.R. § 405.1102Request for Council review when ALJ or attorney adjudicator issues decision or dismissal.
- 42 C.F.R. § 405.1106Where a request for review or escalation may be filed.
- 42 C.F.R. § 405.1108Council actions when request for review or escalation is filed.
- 42 C.F.R. § 405.1110Council reviews on its own motion.
- 42 C.F.R. § 405.1112Content of request for review.
- 42 C.F.R. § 405.1114Dismissal of request for review.
- 42 C.F.R. § 405.1116Effect of dismissal of request for Council review or request for hearing.
- 42 C.F.R. § 405.1118Obtaining evidence from the Council.
- 42 C.F.R. § 405.1120Filing briefs with the Council.
- 42 C.F.R. § 405.1122What evidence may be submitted to the Council.
- 42 C.F.R. § 405.1124Oral argument.
- 42 C.F.R. § 405.1126Case remanded by the Council.
- 42 C.F.R. § 405.1128Action of the Council.
- 42 C.F.R. § 405.1130Effect of the Council's decision.
- 42 C.F.R. § 405.1132Request for escalation to Federal court.
- 42 C.F.R. § 405.1134Extension of time to file action in Federal district court.