C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 498—APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT PARTICIPATION IN THE MEDICARE PROGRAM AND FOR DETERMINATIONS THAT AFFECT THE PARTICIPATION OF ICFs/IID AND CERTAIN NFs IN THE MEDICAID PROGRAM › Subpart B—Initial, Reconsidered, and Revised Determinat…

42 C.F.R. § 498.22

Reconsideration

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(a) Right to reconsideration. CMS or one of its contractors reconsiders an initial determination that affects a prospective provider or supplier, or a hospital seeking to qualify to claim payment for all emergency hospital services furnished in a calendar year, if the affected party files a written request in accordance with paragraphs (b) and (c) of this section. For denial or revocation of enrollment, prospective providers and suppliers and providers and suppliers have a right to reconsideration.

(b) Request for reconsideration: Manner and timing. The affected party specified in paragraph (a) of this section, if dissatisfied with the initial determination may request reconsideration by filing the request—

(1) With CMS or with the State survey agency, or in the case of prospective supplier the entity specified in the notice of initial determination;

(2) Directly or through its legal representative or other authorized official; and

(3) Within 60 days from receipt of the notice of initial determination, unless the time is extended in accordance with paragraph (d) of this section. The date of receipt will be presumed to be 5 days after the date on the notice unless there is a showing that it was, in fact, received earlier or later.

(c) Content of request. The request for reconsideration must state the issues, or the findings of fact with which the affected party disagrees, and the reasons for disagreement.

(d) Extension of time to file a request for reconsideration. (1) If the affected party is unable to file the request within the 60 days specified in paragraph (b) of this section, it may file a written request with CMS, stating the reasons why the request was not filed timely.

(2) CMS will extend the time for filing a request for reconsideration if the affected party shows good cause for missing the deadline.

[52 FR 22446, June 12, 1987, as amended at 73 FR 36462, June 27, 2008]
Notes of Decisions
Cited in 5 cases, 1993–2017 · leading case: Arriva Med. LLC v. United States Dep't of Health & Human Servs., 239 F. Supp. 3d 266 (D.D.C. 2017).
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Arriva Med. LLC v. United States Dep't of Health & Human Servs., 239 F. Supp. 3d 266 (D.D.C. 2017). “” 42 C.F.R. § 498.22 (c). Also available is the opportunity to submit “additional information”—indeed, the “party must submit that information” as this would be its “only opportunity to submit information during the administrative appeals process,” unless the ALJ later gives…”
Assar v. Crescent Counties Found. for Med. Care, 13 F.3d 215 (7th Cir. 1993). “42 C.F.R. § 498.22 . He may then request a hearing before an administrative law judge ( 42 C.”
Boykansky v. Health Care Fin. Admin., 8 F. App'x 516 (6th Cir. 2001). · cites it 3× “1844(f)(3), as HCFA claims, or by 42 C.F.R. §§ 498.22 (b)(3) and 498.95(a), as Boykansky contends.”
Ramaswamy v. Burwell, 83 F. Supp. 3d 846 (E.D. Mo. 2015). · cites it 2× “42 C.F.R. § 498.22 (a). To obtain a reconsideration, the prospective supplier must comply with certain procedures.”
Home Health Care Plus, Inc. v. Burwell, 85 F. Supp. 3d 866 (N.D. Tex. 2014). “The letter, in accordance with 42 C.F.R. §§ 498.22 (a), informed Plaintiff of the administrative appeal process available to challenge the revocation of Medicare billing privileges.”
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