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 D—Hearings

42 C.F.R. § 498.40

Request for hearing

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(a) Manner and timing of request. (1) An affected party entitled to a hearing under § 498.5 may file a request for a hearing with the ALJ office identified in the determination letter.

(2) The affected party or its legal representative or other authorized official must file the request in writing within 60 days from receipt of the notice of initial, reconsidered, or revised determination unless that period is extended in accordance with paragraph (c) of this section. (Presumed date of receipt is determined in accordance with § 498.22(b)(3)).

(b) Content of request for hearing. The request for hearing must—

(1) Identify the specific issues, and the findings of fact and conclusions of law with which the affected party disagrees; and

(2) Specify the basis for contending that the findings and conclusions are incorrect.

(c) Extension of time for filing a request for hearing. If the request was not filed within 60 days—

(1) The affected party or its legal representative or other authorized official may file with the ALJ a written request for extension of time stating the reasons why the request was not filed timely.

(2) For good cause shown, the ALJ may extend the time for filing the request for hearing.

[52 FR 22446, June 12, 1987, as amended at 73 FR 36462, June 27, 2008]
Notes of Decisions
Cited in 16 cases (1 in the last 5 years), 1999–2022 · 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). · cites it 2× “Id at 4-5; see 42 C.F.R. §§ 498.40 -.95. Should it ultimately prevail, Medicare regulations would retroactively reimburse it for any “unpaid claims for services furnished during the overturned period.”
Crestview Parke Care Ctr. v. Tommy Thompson United States Dep't of Health & Human Servs., 373 F.3d 743 (6th Cir. 2004). · cites it 2× “See 42 C.F.R. §§ 498.40 (a)(1), 498.5(k). The case was assigned to an ALJ, but just before the filing of the final exhibit and witness lists in December 2000, the case was reassigned to a different ALJ, who set a hearing date for September 18, 2001.”
Mimiya Hosp., Inc. SNF v. United States Dep't of Health & Human Servs., 331 F.3d 178 (1st Cir. 2003). “The May 26 letter further stated, pursuant to 42 C.F.R. § 498.40 , that Mimiya had sixty days from receipt of the letter to request a hearing before an ALJ to challenge CMS’s determination.”
Emerald Shores Health Care Assocs., LLC v. United States Dep't of Health & Human Servs., 545 F.3d 1292 (11th Cir. 2008). “A Medicare provider can appeal a decision to impose a CMP to an administrative law judge (“ALJ”) pursuant to 42 C.F.R. § 498.40 . At the hearing before the ALJ, CMS must put forward a prima facie case of noncompliance.”
United States Ex Rel. Jamison v. McKesson Corp., 784 F. Supp. 2d 664 (N.D. Miss. 2011). “CSMS appealed that decision on December 9, 2009, to an administrative law judge, pursuant to 42 C.F.R. Section 498.40. CSMS pointed out that copies of its licenses and permits for California and Maryland, which were valid at the time CMS revoked CSMS’s supplier number, had been…”
Beechwood Restorative Care Ctr. v. Thompson, 494 F. Supp. 2d 181 (W.D.N.Y. 2007). “In a letter dated May 22, 1999, Beechwood informed CMS that Beechwood was demanding a hearing a before a federal ALJ in response to CMS’s letters, pursuant to 42 C.F.R. § 498.40 . R. 226. Once it made that demand, Beechwood argues, only CMS (and federal courts, on later review…”
South Valley Health Care Ctr. v. Health Care Fin. Admin., 223 F.3d 1221 (10th Cir. 2000). “The facility may contest imposition of the civil money penalty in a formal eviden-tiary hearing before an administrative law judge (ALJ), see 42 C.F.R. § 498.40 , who may reduce but not set aside the penalty, and whose consideration of penalty amount is limited to the same…”
Life Care Ctr. v. Sec'y of the United States Dep't of Health & Human Servs., 453 F. App'x 610 (6th Cir. 2011). “See 42 C.F.R. § 498.40 . On appeal, CMS pressed violations of five of the 13 cited regulations, contending that it need sustain only a portion of the charges to support its penalty.”
BP Care, Inc. v. Thompson, 337 F. Supp. 2d 1021 (S.D. Ohio 2003). “See 42 C.F.R. § 498.40 . CMS sent such notice to Barbara Parke, and in May of 1999 Barbara Parke appealed the survey’s findings and imposition of the civil money penalty by requesting a hearing before an ALJ.”
Woodstock Care Ctr. v. Thompson, 363 F.3d 583 (6th Cir. 2003). “Woodstock requested a hearing, under 42 C.F.R. § 498.40 , in front of an HHS ALJ.”
SunBridge Care & Rehab. v. Leavitt, 340 F. App'x 929 (4th Cir. 2009). “42 C.F.R. § 498.40 . On June 5, 2007, an ALJ heard the matter and subsequently affirmed the determination.”
Delta Health Grp., Inc. v. United States Dep't of Health & Human Servs., 459 F. Supp. 2d 1207 (N.D. Fla. 2006). “See 42 C.F.R. § 498.40 . If a hearing is requested, the provider will be given an opportunity to appear before the ALJ, to be represented by counsel, to call witnesses, and to present evidence.”
Show all 16 citing cases →
— 42 C.F.R. § 498.40(b) — 1 case
Birchwood Manor Nurs v. HHS (5th Cir. 1999).
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