[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: 42CFR478.24]



[Page 478-479]

 

                         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.  478.24  Opportunity for a party to obtain and submit information.



    (a) Subject to the rules concerning disclosure of QIO information in 

section 1160 of the Act, at the request of a provider, practitioner or 

beneficiary,



[[Page 479]]



the QIO must provide an opportunity for examination of the material upon 

which the initial denial determination was based. The QIO may not 

furnish a provider, practitioner or beneficiary with--

    (1) A record of the QIO deliberation; or

    (2) The identity of the QIO review coordinators, physician advisors, 

or consultants who assisted in the initial denial determination without 

their consent.

    (b) The QIO may require the requester to pay a reasonable fee for 

the reproduction of the material requested.

    (c) The QIO must provide a party with an opportunity to submit new 

evidence before the reconsidered determination is made.