C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS › PART 478—RECONSIDERATIONS AND APPEALS › Subpart B—Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals

42 C.F.R. § 478.38

Effect of a reconsidered determination

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A QIO reconsidered determination is binding upon all parties to the reconsideration unless—

(a) A hearing is requested in accordance with § 478.40 and a final decision rendered; or

(b) The reconsidered determination is later reopened and revised in accordance with § 478.48.

[50 FR 15372, Apr. 17, 1985; 50 FR 41887, Oct. 16, 1985, as amended at 62 FR 25855, May 12, 1997; 62 FR 49938, Sept. 24, 1997. Redesignated at 64 FR 66279, Nov. 24, 1999; 77 FR 68563, Nov. 15, 2012]
Notes of Decisions
Cited in 1 case, 2011–2011 · leading case: Wittenberg v. Oklahoma Health Care Auth., 781 F. Supp. 2d 1221 (N.D. Okla. 2011).
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Wittenberg v. Oklahoma Health Care Auth., 781 F. Supp. 2d 1221 (N.D. Okla. 2011). “42 C.F.R. §§ 478.38 , 478.40. The Oklahoma Administrative Code states that the process afforded providers by [OHCA’s QIO] is the only administrative remedy available to providers.”
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