[Code of Federal Regulations] [Title 42, Volume 3] [Revised as of October 1, 2005] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR498.1] [Page 1088-1089] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PART 498_APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT PARTICIPATION IN THE MEDICARE PROGRAM AND FOR DETERMINATIONS THAT AFFECT THE PARTICIPATION OF ICFs/MR AND CERTAIN NFs IN THE MEDICAID PROGRAM--Table of Contents Subpart A_General Provisions Sec. 498.1 Statutory basis. Subpart A_General Provisions Sec. 498.1 Statutory basis. 498.2 Definitions. 498.3 Scope and applicability. 498.4 NFs subject to appeals process in part 498. 498.5 Appeal rights. 498.10 Appointment of representatives. 498.11 Authority of representatives. 498.13 Fees for services of representatives. 498.15 Charge for transcripts. 498.17 Filing of briefs with the ALJ or Departmental Appeals Board, and opportunity for rebuttal. Subpart B_Initial, Reconsidered, and Revised Determinations 498.20 Notice and effect of initial determinations. 498.22 Reconsideration. 498.23 Withdrawal of request for reconsideration. 498.24 Reconsidered determination. 498.25 Notice and effect of reconsidered determination. Subpart C_Reopening of Initial or Reconsidered Determinations 498.30 Limitation on reopening. 498.32 Notice and effect of reopening and revision. Subpart D_Hearings 498.40 Request for hearing. 498.42 Parties to the hearing. 498.44 Designation of hearing official. 498.45 Disqualification of Administrative Law Judge. 498.47 Prehearing conference. 498.48 Notice of prehearing conference. 498.49 Conduct of prehearing conference. 498.50 Record, order, and effect of prehearing conference. 498.52 Time and place of hearing. 498.53 Change in time and place of hearing. 498.54 Joint hearings. 498.56 Hearing on new issues. 498.58 Subpoenas. 498.60 Conduct of hearing. 498.61 Evidence. 498.62 Witnesses. [[Page 1089]] 498.63 Oral and written summation. 498.64 Record of hearing. 498.66 Waiver of right to appear and present evidence. 498.68 Dismissal of request for hearing. 498.69 Dismissal for abandonment. 498.70 Dismissal for cause. 498.71 Notice and effect of dismissal and right to request review. 498.72 Vacating a dismissal of request for hearing. 498.74 Administrative Law Judge's decision. 498.76 Removal of hearing to Departmental Appeals Board. 498.78 Remand by the Administrative Law Judge. Subpart E_Departmental Appeals Board Review 498.80 Right to request Departmental Appeals Board review of Administrative Law Judge's decision or dismissal. 498.82 Request for Departmental Appeals Board review. 498.83 Departmental Appeals Board action on request for review. 498.85 Procedures before the Departmental Appeals Board on review. 498.86 Evidence admissible on review. 498.88 Decision or remand by the Departmental Appeals Board. 498.90 Effect of Departmental Appeals Board decision. 498.95 Extension of time for seeking judicial review. Subpart F_Reopening of Decisions Made by Administrative Law Judges or the Departmental Appeals Board 498.100 Basis, timing, and authority for reopening an ALJ or Board decision. 498.102 Revision of reopened decision. 498.103 Notice and effect of revised decision. Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). Source: 52 FR 22446, June 12, 1987, unless otherwise noted. Editorial Note: Nomenclature changes to part 498 appear at 61 FR 32349, June 24, 1996. (a) Section 1866(h) of the Act provides for a hearing and for judicial review of the hearing for any institution or agency dissatisfied with a determination that it is not a provider, or with any determination described in section 1866(b)(2) of the Act. (b) Section 1866(b)(2) of the Act lists determinations that serve as a basis for termination of a provider agreement. (c) Sections 1128 (a) and (b) of the Act provide for exclusion of certain individuals or entities because of conviction of crimes related to their participation in Medicare and section 1128(f) provides for hearing and judicial review for exclusions. (d) Section 1156 of the Act establishes certain obligations for practitioners and providers of health care services, and provides sanctions and penalties for those that fail to meet those obligations. (e)-(f) [Reserved] (g) Although Sec. 1866(h) of the Act is silent regarding appeal rights for suppliers and practitioners, the rules in this part include procedures for review of determinations that affect those two groups. (h) Section 1128A(c)(2) of the Act provides that the Secretary may not collect a civil money penalty until the affected entity has had notice and opportunity for a hearing. (i) Section 1819(h) of the Act-- (1) Provides that, for SNFs found to be out of compliance with the requirements for participation, specified remedies may be imposed instead of, or in addition to, termination of the facility's Medicare provider agreement; and (2) Makes certain provisions of section 1128A of the Act applicable to civil money penalties imposed on SNFs. (j) Section 1891(e) of the Act provides that, for home health agencies (HHAs) found to be out of compliance with the conditions of participation, specified remedies may be imposed instead of, or in addition to, termination of the HHA's Medicare provider agreement. (k) Section 1891(f) of the Act-- (1) Requires the Secretary to develop a range of such remedies; and (2) Makes certain provisions of section 1128A of the Act applicable to civil money penalties imposed on HHAs. [52 FR 22446, June 12, 1987, as amended at 59 FR 56251, Nov. 10, 1994; 61 FR 32349, June 24, 1996]