Editorial Note on Part 431
Editorial Note: Nomenclature changes to part 431 appear at 75 FR 48852, Aug. 11, 2010.

§ 431.244 Hearing decisions. ( a ) Hearing recommendations or decisions must be based exclusively on evidence introduced at the hearing.
( b ) The record must consist only of— ( 1 ) The transcript or recording of testimony and exhibits, or an official report containing the substance of what happened at the hearing;
( 2 ) All papers and requests filed in the proceeding; and
( 3 ) The recommendation or decision of the hearing officer.
( c ) The applicant or beneficiary must have access to the record at a convenient place and time.
( d ) In any evidentiary hearing, the decision must be a written one that— ( 1 ) Summarizes the facts; and
( 2 ) Identifies the regulations supporting the decision.
( e ) In a *de novo* hearing, the decision must— ( 1 ) Specify the reasons for the decision; and
( 2 ) Identify the supporting evidence and regulations.
( f ) The agency must take final administrative action as follows: ( 1 ) Ordinarily, within 90 days from: ( i ) The date the enrollee filed an MCO, PIHP, or PAHP appeal, not including the number of days the enrollee took to subsequently file for a State fair hearing; or
( ii ) For all other fair hearings, the date the agency receives a request for a fair hearing in accordance with § 431.221(a)(1).
( 2 ) As expeditiously as the enrollee's health condition requires, but no later than 3 working days after the agency receives, from the MCO, PIHP, or PAHP, the case file and information for any appeal of a denial of a service that, as indicated by the MCO, PIHP, or PAHP— ( i ) Meets the criteria for expedited resolution as set forth in § 438.410(a) of this chapter, but was not resolved within the timeframe for expedited resolution; or
( ii ) Was resolved within the timeframe for expedited resolution, but reached a decision wholly or partially adverse to the enrollee.
( 3 ) In the case of individuals granted an expedited fair hearing in accordance with § 431.224(a)— ( i ) For a claim related to eligibility described in § 431.220(a)(1), or any claim described in § 431.220(a)(2) (relating to a nursing facility) or § 431.220(a)(3) (related to preadmission and annual resident review), as expeditiously as possible and, effective no later than the date described in § 435.1200(i) of this chapter, no later than 7 working days after the agency receives a request for expedited fair hearing; or
( ii ) For a claim related to services or benefits described in § 431.220(a)(1) as expeditiously as possible and, effective no later than the date described in § 435.1200(i) of this chapter, within the time frame in paragraph (f)(2) of this section.
( iii ) For a claim related to services or benefits described in § 431.220(a)(4), (5) or (6), in accordance with the time frame in paragraph (f)(2) of this section.
( 4 ) ( i ) The agency must take final administrative action on a fair hearing request within the time limits set forth in this paragraph except in unusual circumstances when— ( A ) The agency cannot reach a decision because the appellant requests a delay or fails to take a required action; or
( B ) There is an administrative or other emergency beyond the agency's control.
( ii ) The agency must document the reasons for any delay in the appellant's record.
( g ) The public must have access to all agency hearing decisions, subject to the requirements of subpart F of this part for safeguarding of information.
[44 FR 17932, Mar. 29, 1979, as amended at 67 FR 41095, June 14, 2002; 81 FR 27853, May 6, 2016; 81 FR 86449, Nov. 30, 2016]