{"data":{"id":"us/42-cfr-478.28","jurisdiction":"us","citation":"42 CFR 478.28","heading":"Qualifications of a reconsideration reviewer.","body":"A reconsideration reviewer must be someone who is—\n(a) Qualified under § 476.98 of this chapter to make an initial determination.\n(b) Not the individual who made the initial denial determination.\n(c) A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 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"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"e2430a2ae595297117bf1d50763ae6e60f3520f17cba3bd316a8122496e3d316","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-478.26","next":"us/42-cfr-478.30"},"notice":"GroundRules: Original legal text. Not legal advice."}