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 E—Departmental Appeals Board Review

42 C.F.R. § 498.80

Right to request Departmental Appeals Board review of Administrative Law Judge's decision or dismissal

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Either of the parties has a right to request Departmental Appeals Board review of the ALJ's decision or dismissal order, and the parties are so informed in the notice of the ALJ's action.

Notes of Decisions
Cited in 10 cases (2 in the last 5 years), 1988–2025 · leading case: Emerald Shores Health Care Assocs., LLC v. United States Dep't of Health & Human Servs., 545 F.3d 1292 (11th Cir. 2008).
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Emerald Shores Health Care Assocs., LLC v. United States Dep't of Health & Human Servs., 545 F.3d 1292 (11th Cir. 2008). “Both parties have the right to have the DAB review the ALJ’s decision pursuant to 42 C.F.R. § 498.80 . The DAB determines whether the ALJ’s conclusions of law were erroneous and his findings of fact were supported by substantial evidence in the record.”
Lavapies v. Bowen, 687 F. Supp. 1193 (S.D. Ohio 1988). “42 C.F.R. § 498.80 . The Appeals Council’s decision is the final agency action.”
South Valley Health Care Ctr. v. Health Care Fin. Admin., 223 F.3d 1221 (10th Cir. 2000). “See 42 C.F.R. § 498.80 . The Board may *1223 either adopt, modify, or reject the ALJ’s decision, based upon the evidence in the record.”
Clermont Nursing & Convalescent Ctr. v. Leavitt, 142 F. App'x 900 (6th Cir. 2005). “Clermont subsequently appealed the decision by the ALJ to the DAB pursuant to 42 C.F.R. § 498.80 . A three-member panel of the DAB affirmed the decision by the ALJ.”
Omni Manor Nursing Home v. Thompson, 151 F. App'x 427 (6th Cir. 2005). “Omni Manor appealed that decision to a three-member panel of the DAB pursuant to 42 C.F.R. § 498.80 . The DAB fully affirmed the ALJ’s decision in a written opinion.”
Avon Nursing & Rehab. v. Azar (S.D.N.Y. 2019). “42 C.F.R. § 498.80 . The DAB’s decision is binding unless a party “has a right to judicial review and timely files a civil action in a United States District Court or, in the case of a civil money penalty, in a United States Court of Appeals.”
Avon Nursing & Rehab. v. Azar (S.D.N.Y. 2023). “408 ((g)), and the ALJ’s decision can subsequently be appealed to the Appellate Division of the Departmental Appeals Board (“DAB”) ( 42 C.F.R. § 498.80 ). The dispute now before the Court finds its origins in an administrative proceeding relating to an incident at a nursing home.”
NCRNC, LLC v. Kennedy (N.D.N.Y. 2025). “(citing 42 C.F.R. § 498.80 ). "The Board's decision is the 'final decision' of the Secretary, which may be appealed either to a federal appeals court (when civil monetary penalties are imposed) or to a federal district court (in the case of all other remedies).”
Meridian Nursing & Rehab v. Centers for Medicare & Medicaid Servs., 555 F. App'x 177 (3rd Cir. 2014). “The Board had jurisdiction pursuant to 42 C.F.R. § 498.80 . We have jurisdiction pursuant to 42 U.”
Blanchard v. Britthaven, Inc. (N.C. Ct. App. 2014). “See 42 C.F.R. § 498.80 (2013). Utilizing this process, Britthaven appealed CMS' decision to an ALJ, and the ALJ issued a decision affirming CMS' findings of noncompliance with two Medicare regulations, which resulted in immediate jeopardy to resident health and safety at the…”
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