C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED › Subpart I—Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)

42 C.F.R. § 405.1130

Effect of the Council's decision

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The Council's decision is final and binding on all parties unless a Federal district court issues a decision modifying the Council's decision or the decision is revised as the result of a reopening in accordance with § 405.980. A party may file an action in a Federal district court within 60 calendar days after the date it receives notice of the Council's decision.

[74 FR 65338, Dec. 9, 2009, as amended at 82 FR 5124, Jan. 17, 2017]
Notes of Decisions
Cited in 50 cases (19 in the last 5 years), 1987–2026 · leading case: Ctr. for Dermatology & Ski v. Sylvia Mathews Burwell, 770 F.3d 586 (7th Cir. 2014).
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Ctr. for Dermatology & Ski v. Sylvia Mathews Burwell, 770 F.3d 586 (7th Cir. 2014). “42 C.F.R. §§ 405.1130 , 405.1132. Title 28 U.”
Accident, Injury & Rehab v. Alex Azar, II, 943 F.3d 195 (4th Cir. 2019). “See 42 C.F.R. § 405.1130 . The Medicare Act establishes deadlines for completion of each level of review and specifies the consequences if the deadlines are not met.”
Cumberland Cnty. Hosp. Sys., Inc. v. Burwell, 816 F.3d 48 (4th Cir. 2016). “§ 1395ff(b)(l)(A); 42 C.F.R. § 405.1130 . The Medicare Act establishes deadlines for each step in the administrative review process and specifies the consequences when such deadlines are not met.”
Palomar Med. Ctr. v. Kathleen Sebelius, 693 F.3d 1151 (9th Cir. 2012). · cites it 2× “§ 405 (g); 42 C.F.R. § 405.1130 . In certain circumstances, an otherwise final determination or decision may be reopened.”
Illinois Ins. Guar. F v. Xavier Becerra, 33 F.4th 916 (7th Cir. 2022). “See also 42 C.F.R. §§ 405.1130 , 405.1136(a). Section 405(h) bars fed- eral-question jurisdiction for such appeals at any point in the review process.”
Kaiser Found. Health Plan, Inc. v. Burwell, 147 F. Supp. 3d 897 (N.D. Cal. 2015). · cites it 3× “42 C.F.R. § 405.1130 . Thereafter, a party dissatisfied with the- Secretary’s final decision, may seek judicial review.”
Int'l Rehabilitative Sciences Inc. v. Sebelius, 688 F.3d 994 (9th Cir. 2012). “42 C.F.R. § 405.1130 . If the supplier is dissatisfied with the Medicare Appeals Council’s decision, it may challenge that decision in federal court.”
A1 Diabetes & Med. Supply v. Alex Azar II, 937 F.3d 613 (6th Cir. 2019). “42 C.F.R. §§ 405.1130 , 405.1132. Is going through this fourth level of review a jurisdictional prerequisite or a waivable procedural hurdle? At first blush, one could see it either way.”
Commonwealth v. Brownsville Golden Age Nursing Home Inc., 520 A.2d 926 (Pa. Commw. Ct. 1987). “1125 ; social services, 42 C.F.R. §405.1130 ; patient activities, 42 C.”
Casa Colina Hosp. & Centers for Healthcare v. Wright, 698 F. App'x 406 (9th Cir. 2017). “2013 ; see also 42 C.F.R. §§ 405.1130 , 405.1132. Nor is judicial waiver of exhaustion requirements appropriate.”
True Health Diagnostics, LLC v. Azar, 392 F. Supp. 3d 656 (E.D. Tex. 2019). “1136 ; 42 C.F.R. § 405.1130 . II. APPLICABLE LAW "When a Rule 12(b)(1) motion is filed in conjunction with other Rule 12 motions, the court should consider the Rule 12(b)(1) jurisdictional attack before addressing any attack on the merits.”
Willowood of Great Barrington, Inc. v. Sebelius, 638 F. Supp. 2d 98 (D. Mass. 2009). “§ 1395ff(b)(l)(A), 42 C.F.R. §§ 405.1130 , 405.1136, if the amount in controversy is $1,000, indexed for inflation.”
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