[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: 42CFR498.25]



[Page 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. 498.25  Notice and effect of reconsidered determination.



    (a) Notice. (1) CMS mails notice of a reconsidered determination to 

the affected party.

    (2) The notice gives the reasons for the determination.

    (3) If the determination is adverse, the notice specifies the 

conditions or requirements of law or regulations that the affected party 

fails to meet, and informs the party of its right to a hearing.

    (b) Effect. A reconsidered determination is binding unless--

    (1) CMS or the OIG, as appropriate, further revises the revised 

determination; or

    (2) The revised determination is reversed or modified by a hearing 

decision.