CFR

SUBPART I—Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B) (§405.900 to §405.1140)

• 405.900—Basis and scope.
• 405.902—Definitions.
• 405.904—Medicare initial determinations, redeterminations and appeals: General description.
• 405.906—Parties to the initial determinations, redeterminations, reconsiderations, hearings and reviews.
• 405.908—Medicaid State agencies.
• 405.910—Appointed representatives.
• 405.912—Assignment of appeal rights.
• 405.920—Initial determinations.
• 405.921—Notice of initial determination.
• 405.922—Time frame for processing initial determinations.
• 405.924—Actions that are initial determinations.
• 405.926—Actions that are not initial determinations.
• 405.927—Initial determinations subject to the reopenings process.
• 405.928—Effect of the initial determination.
• 405.940—Right to a redetermination.
• 405.942—Time frame for filing a request for a redetermination.
• 405.944—Place and method of filing a request for a redetermination.
• 405.946—Evidence to be submitted with the redetermination request.
• 405.948—Conduct of a redetermination.
• 405.950—Time frame for making a redetermination.
• 405.952—Withdrawal or dismissal of a request for a redetermination.
• 405.954—Redetermination.
• 405.956—Notice of a redetermination.
• 405.958—Effect of a redetermination.
• 405.960—Right to a reconsideration.
• 405.962—Timeframe for filing a request for a reconsideration.
• 405.964—Place and method of filing a request for a reconsideration.
• 405.966—Evidence to be submitted with the reconsideration request.
• 405.968—Conduct of a reconsideration.
• 405.970—Timeframe for making a reconsideration.
• 405.972—Withdrawal or dismissal of a request for a reconsideration.
• 405.974—Reconsideration.
• 405.976—Notice of a reconsideration.
• 405.978—Effect of a reconsideration.
• 405.980—Reopenings of initial determinations, redeterminations, and reconsiderations, hearings and reviews.
• 405.982—Notice of a revised determination or decision.
• 405.984—Effect of a revised determination or decision.
• 405.986—Good cause for reopening.
• 405.990—Expedited access to judicial review.
• 405.1000—Hearing before an ALJ: General rule.
• 405.1002—Right to an ALJ hearing.
• 405.1004—Right to ALJ review of QIC notice of dismissal.
• 405.1006—Amount in controversy required to request an ALJ hearing and judicial review.
• 405.1008—Parties to an ALJ hearing.
• 405.1010—When CMS or its contractors may participate in an ALJ hearing.
• 405.1012—When CMS or its contractors may be a party to a hearing.
• 405.1014—Request for an ALJ hearing.
• 405.1016—Time frames for deciding an appeal before an ALJ.
• 405.1018—Submitting evidence before the ALJ hearing.
• 405.1020—Time and place for a hearing before an ALJ.
• 405.1022—Notice of a hearing before an ALJ.
• 405.1024—Objections to the issues.
• 405.1026—Disqualification of the ALJ.
• 405.1028—Prehearing case review of evidence submitted to the ALJ.
• 405.1030—ALJ hearing procedures.
• 405.1032—Issues before an ALJ.
• 405.1034—When an ALJ may remand a case to the QIC.
• 405.1036—Description of an ALJ hearing process.
• 405.1037—Discovery.
• 405.1038—Deciding a case without a hearing before an ALJ.
• 405.1040—Prehearing and posthearing conferences.
• 405.1042—The administrative record.
• 405.1044—Consolidated hearing before an ALJ.
• 405.1046—Notice of an ALJ decision.
• 405.1048—The effect of an ALJ's decision.
• 405.1050—Removal of a hearing request from an ALJ to the MAC.
• 405.1052—Dismissal of a request for a hearing before an ALJ.
• 405.1054—Effect of dismissal of a request for a hearing before an ALJ.
• 405.1060—Applicability of national coverage determinations (NCDs).
• 405.1062—Applicability of local coverage determinations and other policies not binding on the ALJ and MAC.
• 405.1063—Applicability of laws, regulations and CMS Rulings.
• 405.1064—ALJ decisions involving statistical samples.
• 405.1100—Medicare Appeals Council review: General.
• 405.1102—Request for MAC review when ALJ issues decision or dismissal.
• 405.1104—Request for MAC review when an ALJ does not issue a decision timely.
• 405.1106—Where a request for review or escalation may be filed.
• 405.1108—MAC actions when request for review or escalation is filed.
• 405.1110—MAC reviews on its own motion.
• 405.1112—Content of request for review.
• 405.1114—Dismissal of request for review.
• 405.1116—Effect of dismissal of request for MAC review or request for hearing.
• 405.1118—Obtaining evidence from the MAC.
• 405.1120—Filing briefs with the MAC.
• 405.1122—What evidence may be submitted to the MAC.
• 405.1124—Oral argument.
• 405.1126—Case remanded by the MAC.
• 405.1128—Action of the MAC.
• 405.1130—Effect of the MAC's decision.
• 405.1132—Request for escalation to Federal court.
• 405.1134—Extension of time to file action in Federal district court.
• 405.1136—Judicial review.
• 405.1138—Case remanded by a Federal district court.
• 405.1140—MAC review of ALJ decision in a case remanded by a Federal district court.

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