42 C.F.R. § 498.25
Notice and effect of reconsidered determination.
Cite as 42 C.F.R. § 498.25 (2026)
(a)
Notice.
(1) CMS mails notice of a reconsidered determination to the affected party.
(2) The notice gives the reasons for the determination.
(3) If the determination is adverse, the notice specifies the conditions or requirements of law or regulations that the affected party fails to meet, and informs the party of its right to a hearing.
(b)
Effect.
A reconsidered determination is binding unless—
(1) CMS or the OIG, as appropriate, further revises the revised determination; or
(2) The revised determination is reversed or modified by a hearing decision.