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. § 405.1889

Effect of a revision; issue-specific nature of appeals of revised determinations and decisions

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(a) If a revision is made in a Secretary or contractor determination or a decision by a reviewing entity after the determination or decision is reopened as provided in § 405.1885 of this subpart, the revision must be considered a separate and distinct determination or decision to which the provisions of §§ 405.1811, 405.1834, 405.1835, 405.1837, 405.1875, 405.1877 and 405.1885 of this subpart are applicable.

(b)(1) Only those matters that are specifically revised in a revised determination or decision are within the scope of any appeal of the revised determination or decision.

(2) Any matter that is not specifically revised (including any matter that was reopened but not revised) may not be considered in any appeal of the revised determination or decision.

[73 FR 30266, May 23, 2008]
Notes of Decisions
Cited in 36 cases (3 in the last 5 years), 1981–2024 · leading case: 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).
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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). · cites it 4× “Since that revision in the reimbursement amount is treated as a separate determination under the reopening provisions of the Secretary’s Regulations, see 42 C.F.R. § 405.1889 , the Secretary contends that Edgewater can obtain a hearing on that revised cost item alone.”
Little Co. of Mary Hosp. v. Sebelius, 587 F.3d 849 (7th Cir. 2009). · cites it 2× “42 C.F.R. § 405.1889 (2009). B. The Medicaid Reimbursement Process In This Case Little Company is a hospital that participates in the Medicare program and is entitled to a DSH payment adjustment.”
Albert Einstein Med. Ctr. v. Sullivan, 830 F. Supp. 846 (E.D. Pa. 1992). · cites it 4× “42 C.F.R. § 405.1889 . Under the regulations, a revision is a “separate and distinct determination” for purposes of appeal to the PRRB.”
Baptist Mem'l Hosp. v. Sebelius, 603 F.3d 57 (D.C. Cir. 2010). “930 (quoting 42 C.F.R. § 405.1889 ). Although St. Agnes’s intermediary may not have “revise[d]” the DSH adjustment, the Ninth Circuit has interpreted the appeal regulations as permitting Board review of “all matters the fiscal intermediary had reconsidered upon reopening the…”
Mercy Home Health v. Michael O. Leavitt, Sec'y of Health & Human Servs., 436 F.3d 370 (3rd Cir. 2006). “1835 ; see also 42 C.F.R. § 405.1889 (providing that intermediary determinations after reopening are subject to appeal).”
Baystate Med. Ctr. v. Leavitt, 587 F. Supp. 2d 37 (D.D.C. 2008). “§ 1395oo(a), (d), (f); 42 C.F.R. § 405.1889 ; see also 545 F.Supp.”
French Hosp. Med. Ctr. v. Shalala, 89 F.3d 1411 (9th Cir. 1996). · cites it 12× “The PRRB’s decision rested chiefly on its interpretation of 42 C.F.R. § 405.1889 , the regulation defining revised NPRs.”
Rutland Reg'l Med. Ctr. v. Sullivan, 835 F. Supp. 754 (D. Vt. 1993). · cites it 4× “The effect of a revised NPR on the Provider’s right to a Board hearing is addressed in 42 C.F.R. § 405.1889 . This regulation provides that “such revision shall be considered a separate and distinct determination” for purposes of appeal.”
Hca Health Servs. of Oklahoma, Inc. v. Donna E. Shalala, Sec'y, Dep't of Health & Human Servs., 27 F.3d 614 (D.C. Cir. 1994). “1885 limiting reopenings to “findings on matters at issue in [the original NPR]” and in 42 C.F.R. § 405.1889 characterizing revisions as “separate and distinct determination[s]” for purposes of Board appeals, we do not think it impermissible for the Secretary to interpret the…”
Delaware Cnty. Mem'l Hosp. v. Sullivan, 836 F. Supp. 238 (E.D. Pa. 1991). · cites it 3× “” 42 C.F.R. § 405.1889 (citing to 42 C.F.R.”
Medicare & Medicaid Guide P 45,968 Your Home Visiting Nurse Servs., Inc. v. Sec'y of Health & Human Servs., 132 F.3d 1135 (6th Cir. 1997). “Although the regulations specify that new determinations after a cost report has been reopened are subject to review in the same manner as initial decisions, 42 C.F.R. § 405.1889 , the regulations are silent as to whether a decision not to reopen is subject to review.”
French Hosp. Med. Ctr. v. Shalala, 841 F. Supp. 1468 (N.D. Cal. 1993). · cites it 4× “10 The HCFA Administrator interpreted the reopening regulation 42 C.F.R. § 405.1889 as providing for appeal only of items revised in the NPR.”
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