[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR411.122]



[Page 403]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 411_EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT

--Table of Contents

 

Subpart E_Limitations on Payment for Services Covered Under Group Health 

                        Plans: General Provisions

 

Sec. 411.122  Hearing officer's decision.



    (a) Timing. (1) If the decision is based on a review of the record, 

the hearing officer mails the decision to all known parties within 120 

days from the date of receipt of the request for hearing.

    (2) If the decision is based on an oral hearing, the hearing officer 

mails the decision to all known parties within 120 days from the 

conclusion of the hearing.

    (b) Basis, content, and distribution of hearing decision. (1) The 

written decision is based on substantial evidence and contains findings 

of fact, a statement of reasons, and conclusions of law.

    (2) The hearing officer mails a copy of the decision to each of the 

parties, by certified mail, return receipt requested, and includes a 

notice that the administrator may review the hearing decision at the 

request of a party or on his or her own motion.

    (c) Effect of hearing decision. The hearing officer's decision is 

the final Departmental decision and is binding upon all parties unless 

the Administrator chooses to review that decision in accordance with 

Sec. 411.124 or it is reopened by the hearing officer in accordance 

with Sec. 411.126.