[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: 42CFR498.56]



[Page 1098-1099]

 

                         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 D_Hearings

 

Sec. 498.56  Hearing on new issues.



    (a) Basic rules. (1) Within the time limits specified in paragraph 

(b) of this section, the ALJ may, at the request of either party, or on 

his or her own motion, provide a hearing on new issues that impinge on 

the rights of the affected party.

    (2) The ALJ may consider new issues even if CMS or the OIG has not 

made initial or reconsidered determinations on them, and even if they 

arose after the request for hearing was filed or after a prehearing 

conference.

    (3) The ALJ may give notice of hearing on new issues at any time 

after the hearing request is filed and before the hearing record is 

closed.

    (b) Time limits. The ALJ will not consider any issue that arose on 

or after any of the following dates:

    (1) The effective date of the termination of a provider agreement.

    (2) The date on which it is determined that a supplier no longer 

meets



[[Page 1099]]



the conditions for coverage of its services.

    (3) The effective date of the notice to a hospital of its failure to 

remain in compliance with the qualifications for claiming reimbursement 

for all emergency services furnished to Medicare beneficiaries during 

the calendar year.

    (4) The effective date of the suspension, or of the exclusion from 

coverage of services furnished by a suspended or excluded practitioner, 

provider, or supplier.

    (5) With respect to Medicaid SNFs or ICFs surveyed under section 

1910(c) of the Act--

    (i) The completion date of the survey or resurvey that is the basis 

for a proposed cancellation of approval; or

    (ii) If approval was cancelled before the hearings, because of 

immediate and serious threat to patient health and safety, the effective 

date of cancellation.

    (c) Notice and conduct of hearing on new issues. (1) Unless the 

affected party waives its right to appear and present evidence, notice 

of the time and place of hearing on any new issue will be given to the 

parties in accordance with Sec. 498.52.

    (2) After giving notice, the ALJ will, except as provided in 

paragraph (d) of this section, proceed to hearing on new issues in the 

same manner as on an issue raised in the request for hearing.

    (d) Remand to CMS or the OIG. At the request of either party, or on 

his or her own motion, in lieu of a hearing under paragraph (c) of this 

section, the ALJ may remand the case to CMS or the OIG for consideration 

of the new issue and, if appropriate, a determination. If necessary, the 

ALJ may direct CMS or the OIG to return the case to the ALJ for further 

proceedings.



[52 FR 22446, June 12, 1987, as amended at 53 FR 31335, Aug. 18, 1988]