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 R—Provider Reimbursement Determinations and Appeals

42 C.F.R. § 405.1887

Notice of reopening; effect of reopening

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(a) In exercising its reopening authority under § 405.1885, CMS (for Secretary determinations), the contractor or the reviewing entity, as applicable, must provide written notice to all parties to the determination or decision that is the subject of the reopening. Notices of—

(1) Reopening by a CMS reviewing official or the Board must be sent promptly to the Administrator.

(2) Contractor reopenings of determinations that are currently pending before the Board or the Administrator must meet the requirements specified in § 405.1885(c)(3) and (c)(4) of this subpart.

(b) Upon receipt of the notice required under § 405.1887(a) of this subpart, the parties to the prior Secretary or contractor determination or decision by a reviewing entity, as applicable, must be allowed a reasonable period of time in which to present any additional evidence or argument in support of their positions.

(c) Upon concluding its reopening, CMS, the contractor or the reviewing entity, as applicable, must provide written notice promptly to all parties to the determination or decision that is the subject of the reopening, informing the parties as to what matter(s), if any, is revised, with a complete explanation of the basis for any revision.

(d) A reopening by itself does not extend appeal rights. Any matter that is reconsidered during the course of a reopening, but is not revised, is not within the proper scope of an appeal of a revised determination or decision (as described in § 405.1889 of this subpart).

[73 FR 30266, May 23, 2008]
Notes of Decisions
Cited in 9 cases (1 in the last 5 years), 1989–2021 · leading case: Maine Med. Ctr. v. Burwell, 841 F.3d 10 (1st Cir. 2016).
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Maine Med. Ctr. v. Burwell, 841 F.3d 10 (1st Cir. 2016). · cites it 2× “See 42 C.F.R. § 405.1887 (a). At that point, the hospital “shall be allowed a reasonable period of time in which to present any additional evidence or argument in support of [its] position.”
Little Co. of Mary Hosp. v. Sebelius, 587 F.3d 849 (7th Cir. 2009). · cites it 2× “Little Company points to 42 C.F.R. § 405.1887 , requiring the Intermediary to explain only its decision to make revisions, not its reopening decisions, to support its argument that the Intermediary’s silence is not determinative.”
The EDGEWATER Hosp., INC., Plaintiff-Appellee, v. Otis R. BOWEN, M.D., Sec'y of Health & Human Servs., Defendant-Appellant, 857 F.2d 1123 (7th Cir. 1989). “Furthermore, Edgewater properly filed its appeal of the revised determination within 180 days of the second NPR.”
Select Specialty Hosp. - Denver, Inc. v. Sebelius, 848 F. Supp. 2d 13 (D.D.C. 2012). “PROCEDURAL HISTORY Pursuant to 42 C.F.R. § 405.1887 , Plaintiffs appealed the fiscal year 2004 and fiscal year 2005 NPRs to the PRRB.”
Empire Health Found. v. Burwell, 209 F. Supp. 3d 261 (D.D.C. 2016). “” 42 C.F.R. § 405.1887 (b)—(c); see St. Mary of Nazareth, 741 F.”
Saint Francis Med. Ctr. v. Burwell, 239 F. Supp. 3d 237 (D.D.C. 2017). “¶ 26; 42 C.F.R. § 405.1887 . On April 5, 2015, the Board issued a final decision in this matter.”
Delaware Cnty. Mem'l Hosp. v. Sullivan, 836 F. Supp. 238 (E.D. Pa. 1991). “Aetna informed DCMH that the reopening was pursuant to 42 C.F.R. § 405.1887 (providing for notice to a provider of a reopening).”
Firsthealth Moore Reg'l Hosp. v. Azar (D.D.C. 2021). · cites it 3× “16-1 (noting that “appeals of post-reopening revised NPRs are limited to the specific matters at issue that are adjusted by the Contractor in the revised NPR” (citing 42 C.F.R. § 405.1887 (d))). A Revised NPR is “‘final and binding’ unless it is further revised as a result of an…”
Little Co. of Mary Hospita v. Kathleen Sebelius (7th Cir. 2009). · cites it 2× “Little Company points to 42 C.F.R. § 405.1887 , requiring the Intermediary to explain only its decision to make revisions, not its reopening deci- sions, to support its argument that the Intermediary’s silence is not determinative.”
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