[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: 42CFR498.22]



[Page 1095-1096]

 

                         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 B_Initial, Reconsidered, and Revised Determinations

 

Sec. 498.22  Reconsideration.



    (a) Right to reconsideration. CMS reconsiders any initial 

determination that affects a prospective provider or supplier, or a 

hospital seeking to qualify to claim payment for all emergency hospital 

services furnished in a calendar year, if the affected party files a 

written request in accordance with paragraphs (b) and (c) of this 

section. (None of the determinations made by the OIG are subject to 

reconsideration.)

    (b) Request for reconsideration: Manner and timing. The affected 

party specified in paragraph (a) of this section, if dissatisfied with 

the initial determination may request reconsideration by filing the 

request--

    (1) With CMS or with the State survey agency;

    (2) Directly or through its legal representative or other authorized 

official; and

    (3) Within 60 days from receipt of the notice of initial 

determination, unless the time is extended in accordance with paragraph 

(d) of this section. The date of receipt will be presumed to be 5 days 

after the date on the notice unless there is a showing that it was, in 

fact, received earlier or later.

    (c) Content of request. The request for reconsideration must state 

the issues, or the findings of fact with which the affected party 

disagrees, and the reasons for disagreement.

    (d) Extension of time to file a request for reconsideration. (1) If 

the affected party is unable to file the request within the 60 days 

specified in paragraph (b) of



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this section, it may file a written request with CMS, stating the 

reasons why the request was not filed timely.

    (2) CMS will extend the time for filing a request for 

reconsideration if the affected party shows good cause for missing the 

deadline.