[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: 42CFR478.36]



[Page 480]

 

                         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.  478.36  Record of reconsideration.



    (a) QIO requirements. A QIO must maintain the record of its 

reconsideration until the later of the following:

    (1) Four years after the date on the notice of the QIO's 

reconsidered determination.

    (2) Completion of litigation and the passage of the time period for 

filing all appeals.

    (b) Contents of the record. The record of the reconsideration must 

include:

    (1) The initial determination.

    (2) The basis for the initial determination.

    (3) Documentation of the date of the receipt of the request for 

reconsideration.

    (4) The detailed basis for the reconsidered determination.

    (5) Evidence submitted by the parties.

    (6) A copy of the notice of the reconsidered determination that was 

provided to the parties.

    (7) Documentation of the delivery or mailing and, if appropriate, 

the receipt of the notice of the reconsidered determination by the 

parties.

    (c) Confidentiality. The record of a QIO reconsideration is subject 

to prohibitions against disclosure of information as specified in 

section 1160 of the Act.