Opinion ID: 672843
Heading Depth: 4
Heading Rank: 1

Heading: An intermediary determination has been made with respect to the provider; and

Text: 21 (2) The provider has filed a written request for a hearing before the Board under the provisions described in Sec. 405.1841(a)(1); and 22 (3) The amount in controversy ... is $10,000 or more. 23 Appellant argues that because 42 C.F.R. Sec. 405.1801(a)(1) in turn defines intermediary determination as a determination of the amount of total reimbursement due the provider and because only the entire NPR fits that description, appeals on reopening cannot be limited exclusively to the issues revisited on reopening. Furthermore, HCA points to the incorporated 42 C.F.R. Sec. 405.1841(a)(1), which provides in full: 24 The request for a Board hearing must be filed in writing with the Board within 180 days of the date the notice of the intermediary's determination was mailed to the provider or, where notice of the determination was not timely rendered, within 180 days after the expiration of the period specified in Sec. 405.1835(c) [12 months after receipt by intermediary of a provider's cost report]. Such request for board hearing must identify the aspects of the determination with which the provider is dissatisfied, explain why the provider believes the determination is incorrect in such particulars, and be accompanied by any documenting evidence the provider considers necessary to support its position. Prior to the commencement of the hearing proceedings, the provider may identify in writing additional aspects of the intermediary's determination with which it is dissatisfied and furnish any documentary evidence in support thereof. 25 HCA relies on the last sentence of this section to bolster its argument that it may add matters pertaining to the determination of the total amount of reimbursement prior to the Board hearing on appeal of the reopening. Finally, appellant invokes the Board's power under the regulations 26 to affirm, modify, or reverse a determination of an intermediary with respect to a cost report and to make any other modifications on matters covered by such cost report ... even though such matters were not considered in the intermediary's determination. 27 Id. at Sec. 405.1869. According to HCA, this section evidences that the Board's jurisdiction over appeals from reopenings is as broad as its authority over appeals from an original NPR. 28 In light of the explicit language in 42 C.F.R. Sec. 405.1885 limiting reopenings to findings on matters at issue in [the original NPR] and in 42 C.F.R. Sec. 405.1889 characterizing revisions as separate and distinct determination[s] for purposes of Board appeals, we do not think it impermissible for the Secretary to interpret the intermediary determination on reopening as limited to the particular matters revisited on the second go-round. Nor do we find dispositive the final sentence in Sec. 405.1841(a)(1) which permits a provider prior to the Board hearing to identify ... additional aspects of the intermediary's determination with which it is dissatisfied. Nothing in Sec. 405.1841(a)(1) specifically permits expanding the scope of the Board's inquiry beyond the intermediary determination which is on review. Section 405.1841(a)(1), in other words, does not answer the question of whether in post-reopening appeals the intermediary determination encompasses the entire NPR or is limited to the specific issues decided on reopening. Even if such appeals are limited to the specific issues on reopening, the last sentence of Sec. 405.1841(a)(1) still finds application as follows: after appealing an intermediary's reopening, a provider is permitted to add other issues also reconsidered on reopening even though the provider had not noted those additional issues in his first petition for appeal from the reopening. Moreover, Sec. 405.1841(a)(1) is aimed principally at replicating the filing requirements, such as the 180-day deadline, for challenges to an intermediary's reopening decision. Section 405.1869 is similarly unilluminating as to the Board's power of review. While that section tracks the Board's expansive power of review under 42 U.S.C. Sec. 1395oo (d), the regulation is cast in general terms and is not necessarily applicable in its entirety to Board reviews of reopening decisions. Section 405.1869 cannot, without more, negate the more narrowly drawn Sec. 405.1889 which is the primary source of the provider's right to appeal a reopening. In sum, even viewing the regulations in the light most favorable to HCA, we find them at best ambiguous and the Secretary's interpretation of the limited scope of appeals from reopenings a permissible one.