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CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER B—MEDICARE PROGRAM (parts 405 to 426) > PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED > SUBPART G—Reconsiderations and Appeals Under Medicare Part A (§405.701 to §405.753) > 405.705—Actions which are not initial determinations.

CFR

405.705—Actions which are not initial determinations.

An initial determination under Part A of Medicare does not include determinations relating to:
(a) The reasonable cost of items or services furnished under Part A of Medicare;
(b) Whether an institution or agency meets the conditions for participation in the program;
(c) Whether an individual is qualified for use of the expedited appeals process as provided in § 405.718 ;
(d) An action regarding compromise of a claim arising under the Medicare program, or termination or suspension of collection action on such a claim under the Federal Claims Collection Act of 1966 (31 U.S.C. 3711 ). See 20 CFR 404.515 for overpayment claims against an individual, § 405.376 for overpayment claims against a provider, physician or other supplier, and § 408.110 for claims concerning unpaid Medicare premiums;
(e) The transfer or discharge of residents of skilled nursing facilities in accordance with § 483.12 of this chapter; or
(f) The preadmission screening and annual resident review processes required by part 483 subparts C and E of this chapter.
[45 FR 73932, Nov. 7, 1980; 46 FR 24565, May 1, 1981, as amended at 52 FR 22454, June 12, 1987; 52 FR 48123, Dec. 18, 1987; 57 FR 56504, Nov. 30, 1992; 61 FR 63749, Dec. 2, 1996]
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