Find Laws Find Lawyers Free Legal Forms USA State Laws
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 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT > SUBPART U—Reopening, ALJ Hearings, MAC review, and Judicial Review (§423.1968 to §423.2140) > 423.1978—Reopening determinations and decisions.

CFR

423.1978—Reopening determinations and decisions.

(a) A coverage determination or redetermination made by a Part D plan sponsor, a reconsideration made by the independent review entity specified in § 423.600, or the decision of an ALJ or the MAC that is otherwise binding may be reopened and revised by the entity that made the determination or decision as provided in § 423.1980 through § 423.1986.
(b) The filing of a request for reopening does not relieve the Part D plan sponsor of its obligation to make payment or provide benefits as specified in § 423.636 or § 423.638 of this chapter.
(c) Once an entity issues a revised determination or decision, the revisions made by the decision may be appealed.
(d) A decision not to reopen by the Part D plan sponsor or any other entity is not subject to review.
Tips