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. § 405.962

Timeframe for filing a request for a reconsideration

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(a) Timeframe for filing a request. Except as provided in paragraph (b) of this section and in § 405.974(b)(1), regarding a request for QIC reconsideration of a contractor's dismissal of a redetermination request, any request for a reconsideration must be filed within 180 calendar days from the date the party receives the notice of the redetermination.

(1) For purposes of this section, the date of receipt of the redetermination will be presumed to be 5 calendar days after the date of the notice of redetermination, unless there is evidence to the contrary.

(2) For purposes of meeting the 180 calendar day filing deadline, the request is considered as filed on the date it is received by the QIC.

(b) Extending the time for filing a request—(1) General rule. A QIC may extend the 180 calendar day timeframe for filing a request for reconsideration for good cause.

(2) How to request an extension. A party to the redetermination must file its request for an extension of the time for filing the reconsideration request with its request for reconsideration. A party should include evidence to support the request for extension. The request for reconsideration and request for extension must—

(i) Be in writing;

(ii) State why the request for reconsideration was not filed within the required timeframe; and

(iii) Meet the requirements of § 405.964.

(3) How the QIC determines whether good cause exists. In determining whether a party has good cause for missing a deadline to request reconsideration, the QIC applies the good cause provisions contained in § 405.942(b)(2) and (b)(3).

[70 FR 11472, Mar. 8, 2005, as amended at 74 FR 65334, Dec. 9, 2009]
Notes of Decisions
Cited in 2 cases (1 in the last 5 years), 2014–2022 · leading case: Cgi Fed. Inc. v. United States, 118 Fed. Cl. 337 (Fed. Cl. 2014).
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Cgi Fed. Inc. v. United States, 118 Fed. Cl. 337 (Fed. Cl. 2014). “AR Tab 20f at 539; 42 C.F.R § 405.962(a). In CMS parlance, this level of appeal is referred to as “reconsideration,” “the QIC level,” and “the second level” interchangeably.”
First United Methodist Church v. Becerra (D. Neb. 2022). “42 C.F.R. § 405.962 (a). As to the nature of a reconsideration, A reconsideration consists of an independent, on-the-record review of an initial determination, including the redetermination and all issues related to payment of the claim.”
— 42 C.F.R. § 405.962(a) — 1 case
Cgi Fed. Inc. v. United States, 118 Fed. Cl. 337 (Fed. Cl. 2014). “AR Tab 20f at 539; 42 C.F.R § 405.962(a). In CMS parlance, this level of appeal is referred to as “reconsideration,” “the QIC level,” and “the second level” interchangeably.”
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