Source: https://www.law.cornell.edu/cfr/text/42/405.1056
Timestamp: 2020-02-26 23:41:15
Document Index: 639291458

Matched Legal Cases: ['§ 405', '§ 405', '§ 405', '§ 405', '§ 405', '§ 426', '§ 426', '§ 426']

42 CFR § 405.1056 - Remands of requests for hearing and requests for review. | CFR | US Law | LII / Legal Information Institute
Section 405.1056. Remands of requests for hearing and requests for review.
42 CFR § 405.1056 - Remands of requests for hearing and requests for review.
(a) Missing appeal determination or case record.
(1) If an ALJ or attorney adjudicator requests an official copy of a missing redetermination or reconsideration for an appealed claim in accordance with § 405.1034, and the QIC or another contractor does not furnish the copy within the time frame specified in § 405.1034, the ALJ or attorney adjudicator may issue a remand directing the QIC or other contractor to reconstruct the record or, if it is not able to do so, initiate a new appeal adjudication.
(c) Requested remand -
(1) Request contents and timing. At any time prior to an ALJ or attorney adjudicator issuing a decision or dismissal, the appellant and CMS or one of its contractors may jointly request a remand of the appeal to the entity that conducted the reconsideration. The request must include the reasons why the appeal should be remanded and indicate whether remanding the case will likely resolve the matter in dispute.
(d) Remanding a QIC's dismissal of a request for reconsideration.
(1) Consistent with § 405.1004(b), an ALJ or attorney adjudicator will remand a case to the appropriate QIC if the ALJ or attorney adjudicator determines that a QIC's dismissal of a request for reconsideration was in error.
(e) Relationship to local and national coverage determination appeals process.
(1) An ALJ or attorney adjudicator remands an appeal to the QIC that made the reconsideration if the appellant is entitled to relief pursuant to § 426.460(b)(1), § 426.488(b), or § 426.560(b)(1) of this chapter.