[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: 42CFR478.44]



[Page 481]

 

                         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.  478.44  Determining the amount in controversy for a hearing.



    (a) After an individual appellant has submitted a request for a 

hearing, the ALJ determines the amount in controversy in accordance with 

Sec.  405.740(a) of this chapter for Part A services or Sec.  405.817(a) 

of this chapter for Part B services. When two or more appellants submit 

a request for hearing, the ALJ determines the amount in controversy in 

accordance with Sec.  405.740(b) of this chapter for Part A services and 

Sec.  405.817(b) of this chapter for Part B services.

    (b) If the ALJ determines that the amount in controversy is less 

than $200, the ALJ, without holding a hearing, notifies the parties to 

the hearing that the parties have 15 calendar days to submit additional 

evidence to prove that the amount in controversy is at least $200.

    (c) At the end of the 15-day period, if the ALJ determines that the 

amount in controversy is less than $200, the ALJ, without holding a 

hearing, dismisses the request for a hearing without ruling on the 

substantive issues involved in the appeal and notifies the parties to 

the hearing and the QIO that the QIO reconsidered determination is 

conclusive for Medicare payment purposes.



[50 FR 15372, Apr. 17, 1985, as amended at 59 FR 12184, Mar. 16, 1994. 

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