[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR478.20]



[Page 478]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 478_RECONSIDERATIONS AND APPEALS--Table of Contents

 

     Subpart B_Utilization and Quality Control Quality Improvement 

             Organization (QIO) Reconsiderations and Appeals

 

Sec.  478.20  Time limits for requesting reconsideration.



    (a) Basic rules. (1) Except for a request for expedited 

reconsideration as provided in paragraph (c) of this section, or a late 

request with good cause under Sec.  473.22, a dissatisfied party must 

file a request for reconsideration within 60 days after receipt of the 

notice of an initial determination.

    (2) The date of receipt of the notice of the initial determination 

is presumed to be five days after the date on the notice, unless there 

is a reasonable showing to the contrary.

    (3) A request is considered filed on the date it is postmarked.

    (b) Late filing of request. A QIO will accept a request filed after 

60 days after receipt of the notice of the initial determination if the 

QIO finds under the criteria set forth in Sec.  473.22 that there was 

good cause for the party's failure to file a timely request.

    (c) Request for expedited reconsideration. A request for an 

expedited reconsideration under Sec.  473.18(c) must be submitted within 

three days after receipt of the notice of the initial denial 

determination.