GroundRules
42 CFR 422.696: Reopening of a contract determination or decision of a hearing officer or the Administrator.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER B—MEDICARE PROGRAM
- PART 422—MEDICARE ADVANTAGE PROGRAM
- Subpart N—Medicare Contract Determinations and Appeals
(a) Contract determination. CMS may reopen and revise an initial determination upon its own motion.
(b) Decision of hearing officer. A decision of a hearing officer that is unfavorable to any party and is otherwise final may be reopened and revised by the hearing officer upon the officer's own motion within one year of the notice of the hearing decision. Another hearing officer designated by CMS may reopen and revise the decision if the hearing officer who issued the decision is unavailable.
(c) Decision of Administrator. A decision by the Administrator that is otherwise final may be reopened and revised by the Administrator upon the Administrator's own motion within one year of the notice of the Administrator's decision.
(d) Notices. (1) The notice of reopening and of any revisions following the reopening is mailed to the parties.
(2) The notice of revision specifies the reasons for revisions.
Collected 2026-08-27T02:26:11Z. Source file · JSON