Code of Federal Regulations · Subpart
Subpart I — Determinations, Redeterminations, Reconsiderations, And Appeals Under Original Medicare (part A And Part B)
42 C.F.R. pt. 405, subpt. I
- § 405.900 Basis And Scope
- § 405.902 Definitions
- § 405.903 Prepayment Review
- § 405.904 Medicare Initial Determinations, Redeterminations And Appeals: General Description
- § 405.906 Parties To The Initial Determinations, Redeterminations, Reconsiderations, Hearings, And Reviews
- § 405.908 Medicaid State Agencies
- § 405.910 Appointed Representatives
- § 405.912 Assignment Of Appeal Rights
- § 405.920 Initial Determinations
- § 405.921 Notice Of Initial Determination
- § 405.922 Time Frame For Processing Initial Determinations
- § 405.924 Actions That Are Initial Determinations
- § 405.925 Decisions Of Utilization Review Committees
- § 405.926 Actions That Are Not Initial Determinations
- § 405.927 Initial Determinations Subject To The Reopenings Process
- § 405.928 Effect Of The Initial Determination
- § 405.929 Post-payment Review
- § 405.930 Failure To Respond To Additional Documentation Request
- § 405.931 Scope, Basis, And Definitions
- § 405.932 Right To Appeal A Denial Of Part A Coverage Resulting From A Change In Patient Status
- § 405.934 Reconsideration
- § 405.936 Hearings Before An Alj And Decisions By An Alj Or Attorney Adjudicator
- § 405.938 Review By The Medicare Appeals Council And Judicial Review
- § 405.940 Right To A Redetermination
- § 405.942 Time Frame For Filing A Request For A Redetermination
- § 405.944 Place And Method Of Filing A Request For A Redetermination
- § 405.946 Evidence To Be Submitted With The Redetermination Request
- § 405.947 Notice To The Beneficiary Of Applicable Plan's Request For A Redetermination
- § 405.948 Conduct Of A Redetermination
- § 405.950 Time Frame For Making A Redetermination
- § 405.952 Withdrawal Or Dismissal Of A Request For A Redetermination
- § 405.954 Redetermination
- § 405.956 Notice Of A Redetermination
- § 405.958 Effect Of A Redetermination
- § 405.960 Right To A Reconsideration
- § 405.962 Timeframe For Filing A Request For A Reconsideration
- § 405.964 Place And Method Of Filing A Request For A Reconsideration
- § 405.966 Evidence To Be Submitted With The Reconsideration Request
- § 405.968 Conduct Of A Reconsideration
- § 405.970 Timeframe For Making A Reconsideration Following A Contractor Redetermination
- § 405.972 Withdrawal Or Dismissal Of A Request For Reconsideration Or Review Of A Contractor's Dismissal Of A Request For Redetermination
- § 405.974 Reconsideration And Review Of A Contractor's Dismissal Of A Request For Redetermination
- § 405.976 Notice Of A Reconsideration
- § 405.978 Effect Of A Reconsideration
- § 405.980 Reopening Of Initial Determinations, Redeterminations, Reconsiderations, Decisions, And Reviews
- § 405.982 Notice Of A Revised Determination Or Decision
- § 405.984 Effect Of A Revised Determination Or Decision
- § 405.986 Good Cause For Reopening
- § 405.990 Expedited Access To Judicial Review
- § 405.1000 Hearing Before An Alj And Decision By An Alj Or Attorney Adjudicator: General Rule
- § 405.1002 Right To An Alj Hearing
- § 405.1004 Right To A Review Of Qic Notice Of Dismissal
- § 405.1006 Amount In Controversy Required For An Alj Hearing And Judicial Review
- § 405.1008 Parties To The Proceedings On A Request For An Alj Hearing
- § 405.1010 When Cms Or Its Contractors May Participate In The Proceedings On A Request For An Alj Hearing
- § 405.1012 When Cms Or Its Contractors May Be A Party To A Hearing
- § 405.1014 Request For An Alj Hearing Or A Review Of A Qic Dismissal
- § 405.1016 Time Frames For Deciding An Appeal Of A Qic Reconsideration Or Escalated Request For A Qic Reconsideration
- § 405.1018 Submitting Evidence
- § 405.1020 Time And Place For A Hearing Before An Alj
- § 405.1022 Notice Of A Hearing Before An Alj
- § 405.1024 Objections To The Issues
- § 405.1026 Disqualification Of The Alj Or Attorney Adjudicator
- § 405.1028 Review Of Evidence Submitted By Parties
- § 405.1030 Alj Hearing Procedures
- § 405.1032 Issues Before An Alj Or Attorney Adjudicator
- § 405.1034 Requesting Information From The Qic
- § 405.1036 Description Of An Alj Hearing Process
- § 405.1037 Discovery
- § 405.1038 Deciding A Case Without A Hearing Before An Alj
- § 405.1040 Prehearing And Posthearing Conferences
- § 405.1042 The Administrative Record
- § 405.1044 Consolidated Proceedings
- § 405.1046 Notice Of An Alj Or Attorney Adjudicator Decision
- § 405.1048 The Effect Of An Alj's Or Attorney Adjudicator's Decision
- § 405.1050 Removal Of A Hearing Request From Omha To The Council
- § 405.1052 Dismissal Of A Request For A Hearing Before An Alj Or Request For Review Of A Qic Dismissal
- § 405.1054 Effect Of Dismissal Of A Request For A Hearing Or Request For Review Of Qic Dismissal
- § 405.1056 Remands Of Requests For Hearing And Requests For Review
- § 405.1058 Effect Of A Remand
- § 405.1060 Applicability Of National Coverage Determinations (ncds)
- § 405.1062 Applicability Of Local Coverage Determinations And Other Policies Not Binding On The Alj Or Attorney Adjudicator And Council
- § 405.1063 Applicability Of Laws, Regulations, Cms Rulings, And Precedential Decisions
- § 405.1100 Medicare Appeals Council Review: General
- § 405.1102 Request For Council Review When Alj Or Attorney Adjudicator Issues Decision Or Dismissal
- § 405.1106 Where A Request For Review Or Escalation May Be Filed
- § 405.1108 Council Actions When Request For Review Or Escalation Is Filed
- § 405.1110 Council Reviews On Its Own Motion
- § 405.1112 Content Of Request For Review
- § 405.1114 Dismissal Of Request For Review
- § 405.1116 Effect Of Dismissal Of Request For Council Review Or Request For Hearing
- § 405.1118 Obtaining Evidence From The Council
- § 405.1120 Filing Briefs With The Council
- § 405.1122 What Evidence May Be Submitted To The Council
- § 405.1124 Oral Argument
- § 405.1126 Case Remanded By The Council
- § 405.1128 Action Of The Council
- § 405.1130 Effect Of The Council's Decision
- § 405.1132 Request For Escalation To Federal Court
- § 405.1134 Extension Of Time To File Action In Federal District Court
- § 405.1136 Judicial Review
- § 405.1138 Case Remanded By A Federal District Court
- § 405.1140 Council Review Of Alj Decision In A Case Remanded By A Federal District Court