GroundRules
42 CFR 478.24: Opportunity for a party to obtain and submit information.
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 F—QUALITY IMPROVEMENT ORGANIZATIONS
- PART 478—RECONSIDERATIONS AND APPEALS
- Subpart B—Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals
(a) Subject to the rules concerning disclosure of QIO information in section 1160 of the Act, at the request of a provider, practitioner or beneficiary, the QIO must provide an opportunity for examination of the material upon which the initial denial determination was based. The QIO may not furnish a provider, practitioner or beneficiary with—
(1) A record of the QIO deliberation; or
(2) The identity of the QIO review coordinators, physician advisors, or consultants who assisted in the initial denial determination without their consent.
(b) The QIO may require the requester to pay a reasonable fee for the reproduction of the material requested.
(c) The QIO must provide a party with an opportunity to submit new evidence before the reconsidered determination is made.
Collected 2026-08-27T02:26:11Z. Source file · JSON