[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: 42CFR478.22]



[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.  478.22  Good cause for late filing of a request for a 



reconsideration or hearing.



    (a) General Rule. In determining whether a party has good cause for 

not filing a request for reconsideration or hearing timely, the QIO or 

ALJ, respectively, must consider the following:

    (1) What circumstances kept the party from making the request on 

time.

    (2) Whether an action by the QIO misled the party.

    (3) Whether the party understood the requirements of the Act as 

affected by amendments to the Act, other legislation, or court 

decisions.

    (b) Examples. Examples of circumstances in which good cause may 

exist include, but are not limited to, the following:

    (1) A party was seriously ill and was prevented from requesting a 

reconsideration in person, through another person, or in writing.

    (2) There was a death or serious illness in a party's immediate 

family.

    (3) Important records were accidentally destroyed or damaged by fire 

or other cause.

    (4) A party made a diligent effort but could not find or obtain 

necessary relevent information within the appropriate time period.

    (5) A party requested additional information to further explain the 

determination within the time limit, and requested reconsideration 

within 60 days of receiving the explanation (or within 30 days for a 

Departmental Appeals Board hearing).

    (6) The QIO gave the party incorrect or incomplete information about 

when and how to request a reconsideration or hearing.

    (7) A party sent the request to another Government agency in good 

faith within the time limit, but the request did not reach an office 

authorized to receive the request until after the time period had 

expired.

    (8) Other unusual or unavoidable circumstances exist that--

    (i) Show that a party could not have known of the need to file 

timely; or

    (ii) Prevented a party from filing timely.



[50 FR 15372, Apr. 17, 1985, as amended at 61 FR 32349, June 24, 1996. 

Redesignated at 64 FR 66279, Nov. 24, 1999]