[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: 42CFR498.32]



[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 C_Reopening of Initial or Reconsidered Determinations

 

Sec. 498.32  Notice and effect of reopening and revision.



    (a) Notice. (1) CMS or the OIG, as appropriate, gives the affected 

party notice of reopening and of any revision of the reopened 

determination.

    (2) The notice of revised determination states the basis or reason 

for the revised determination.

    (3) If the determination is that a supplier or prospective supplier 

does not meet the conditions for coverage of its services, the notice 

specifies the conditions with respect to which the affected party fails 

to meet the requirements of law and regulations, and informs the party 

of its right to a hearing.

    (b) Effect. A revised determination is binding unless

    (1) The affected party requests a hearing before an ALJ; or

    (2) CMS or the OIG further revises the revised determination.