Source: https://www.law.cornell.edu/cfr/text/42/405.980
Timestamp: 2017-04-29 05:44:50
Document Index: 260232520

Matched Legal Cases: ['art 405', '§ 405', '§ 405', '§ 405', '§ 405', '§ 405', '§ 405', '§ 405', '§ 405']

42 CFR 405.980 - Reopening of initial determinations, redeterminations, reconsiderations, hearings, and reviews. | US Law | LII / Legal Information Institute
CFR › Title 42 › Chapter IV › Subchapter B › Part 405 › Subpart I › Section 405.980 42 CFR 405.980 - Reopening of initial determinations, redeterminations, reconsiderations, hearings, and reviews.
§ 405.980 Reopening of initial determinations, redeterminations, reconsiderations, hearings, and reviews.
Link to an amendment published at 82 FR 5108, Jan. 17, 2017.
(1) A reopening is a remedial action taken to change a binding determination or decision that resulted in either an overpayment or underpayment, even though the binding determination or decision may have been correct at the time it was made based on the evidence of record. That action may be taken by - (i) A contractor to revise the initial determination or redetermination;
(3) Notwithstanding paragraph (a)(4) of this section, a contractor must process clerical errors (which includes minor errors and omissions) as reopenings, instead of as redeterminations as specified in § 405.940. If the contractor receives a request for reopening and disagrees that the issue is a clerical error, the contractor must dismiss the reopening request and advise the party of any appeal rights, provided the timeframe to request an appeal on the original denial has not expired. For purposes of this section, clerical error includes human or mechanical errors on the part of the party or the contractor such as - (i) Mathematical or computational mistakes;
(5) The contractor's, QIC's, ALJ's, or MAC's decision on whether to reopen is binding and not subject to appeal.
(b)Time frames and requirements for reopening initial determinations and redeterminations initiated by a contractor. A contractor may reopen an initial determination or redetermination on its own motion - (1) Within 1 year from the date of the initial determination or redetermination for any reason.
(c)Time frame and requirements for reopening initial determinations and redeterminations requested by a party.
(1) A party may request that a contractor reopen its initial determination or redetermination within 1 year from the date of the initial determination or redetermination for any reason.
(d)Time frame and requirements for reopening reconsiderations, hearing decisions and reviews initiated by a QIC, ALJ, or the MAC.
(1) A QIC may reopen its reconsideration on its own motion within 180 calendar days from the date of the reconsideration for good cause in accordance with § 405.986. If the QIC's reconsideration was procured by fraud or similar fault, then the QIC may reopen at any time.
(2) An ALJ or the MAC may reopen a hearing decision on its own motion within 180 calendar days from the date of the decision for good cause in accordance with § 405.986. If the hearing decision was procured by fraud or similar fault, then the ALJ or the MAC may reopen at any time.
(3) The MAC may reopen its review decision on its own motion within 180 calendar days from the date of the review decision for good cause in accordance with § 405.986. If the MAC's decision was procured by fraud or similar fault, then the MAC may reopen at any time.
(e)Time frames and requirements for reopening reconsiderations, hearing decisions, and reviews requested by a party.
(1) A party to a reconsideration may request that a QIC reopen its reconsideration within 180 calendar days from the date of the reconsideration for good cause in accordance with § 405.986.
(2) A party to a hearing may request that an ALJ or the MAC reopen a hearing decision within 180 calendar days from the date of the hearing decision for good cause in accordance with § 405.986.
(3) A party to a review may request that the MAC reopen its decision within 180 calendar days from the date of the review decision for good cause in accordance with § 405.986.
[ 70 FR 11472, Mar. 8, 2005, as amended at 70 FR 37703, June 30, 2005; 74 FR 65334, Dec. 9, 2009; 81 FR 7684, Feb. 12, 2016]
20 CFR 418.1355 — What Are the Rules for Reopening a Decision by an Administrative Law Judge of the Office of Medicare Hearings and Appeals (OMHA) or by the Medicare Appeals Council (MAC)?
42 CFR 405.928 — Effect of the Initial Determination.
42 CFR 405.1032 — Issues Before an ALJ.
42 CFR 405.982 — Notice of a Revised Determination or Decision.
42 CFR 405.1130 — Effect of the MAC's Decision.
42 CFR 405.1048 — The Effect of an ALJ's Decision.
42 CFR 405.958 — Effect of a Redetermination.
42 CFR 405.927 — Initial Determinations Subject to the Reopenings Process.
42 CFR 405.978 — Effect of a Reconsideration.