[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: 42CFR418.311]



[Page 932]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 418_HOSPICE CARE--Table of Contents

 

                   Subpart G_Payment for Hospice Care

 

Sec. 418.311  Administrative appeals.



    A hospice that believes its payments have not been properly 

determined in accordance with these regulations may request a review 

from the intermediary or the Provider Reimbursement Review Board (PRRB) 

if the amount in controversy is at least $1,000 or $10,000, 

respectively. In such a case, the procedure in 42 CFR part 405, subpart 

R, will be followed to the extent that it is applicable. The PRRB, 

subject to review by the Secretary under Sec. 405.1874 of this chapter, 

shall have the authority to determine the issues raised. The methods and 

standards for the calculation of the payment rates by CMS are not 

subject to appeal.