[Code of Federal Regulations]
[Title 20, Volume 2]
[Revised as of April 1, 2006]
From the U.S. Government Printing Office via GPO Access
[CITE: 20CFR418]

[Page 1193-1194]
 
                      TITLE 20--EMPLOYEES' BENEFITS
 
               CHAPTER III--SOCIAL SECURITY ADMINISTRATION
 
PART 418_MEDICARE SUBSIDIES--Table of Contents
 
                   Subpart D_Medicare Part D Subsidies
 
Sec.  418.3625  What is the process for administrative review?

    The process for administrative review of initial determinations is 
either a hearing conducted by telephone or a case review. We will 
provide you with a hearing by telephone when you appeal the initial 
determination made on your claim, unless you choose not to participate 
in a telephone hearing. If you choose not to participate in a telephone 
hearing, the review will consist of a case review. The hearing will be 
conducted by an individual who was not involved in making the initial 
determination. The individual who conducts the hearing will make the 
final decision after the hearing. If you are dissatisfied after we have 
made a final decision, you may file an action in Federal district court.
    (a) Notice scheduling the telephone hearing. Once you request a 
telephone hearing, we will schedule the hearing and send you a notice of 
the date and time of the hearing at least 20 days before the hearing. 
The notice will contain a statement of the specific issues to be decided 
and tell you that you may designate a personal representative (as 
defined in 42 CFR 423.772) to represent you during the proceedings. The 
notice will explain the opportunity and procedure for reviewing your 
file and for submitting additional evidence prior to the hearing. It 
also will provide a brief explanation of the proceedings, of the right 
and process to subpoena witnesses and documents, of the procedures for 
requesting a change in the time or date of your hearing, and of the 
procedure for requesting interpreter services.
    (b) Opportunity to review your file. Prior to the telephone hearing, 
you will be able to review the information that was used to make an 
initial determination in your case. You can provide us with additional 
information you wish to have considered at the hearing.
    (c) Hearing waived, rescheduled, or missed. If you decide you do not 
want a hearing by telephone or if you are not available at the time of 
the scheduled hearing, the decision in your case will be made by a case 
review. This means that the decision will be based on the information in 
your file and any additional information you provide. You

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may ask for a change in the time and date of the telephone hearing; this 
should be done at the earliest possible opportunity prior to the 
hearing. Your request must state your reason(s) for needing the change 
in time or date and state the new time and date you want the hearing to 
be held. We will change the time and date, but not necessarily to your 
preferred time or date, of the telephone hearing if you have good cause. 
If you miss the scheduled hearing and the decision in your case is 
decided by a case review, we will provide a hearing, at your written 
request, if we decide you had good cause for missing the scheduled 
hearing. Examples of good cause include, but are not limited to, the 
following:
    (1) You have attempted to obtain a representative but need 
additional time;
    (2) Your representative was appointed within 30 days of the 
scheduled hearing and needs additional time to prepare for the hearing;
    (3) Your representative has a prior commitment to be in court or at 
another administrative hearing on the date scheduled for your hearing;
    (4) A witness who will testify to facts material to your case would 
be unavailable to participate in the scheduled hearing and the evidence 
cannot be obtained any other way;
    (5) You are unrepresented, and you are unable to respond to the 
notice of hearing because of any physical, mental, educational, or 
linguistic limitations (including any lack of facility with the English 
language) that you may have; or
    (6) You did not receive notice of the hearing appointment.
    (d) Witnesses at hearing. When we determine that it is reasonably 
necessary for the full presentation of a case, we may issue a subpoena 
to compel the production of certain evidence or testimony.