 |
Code of Federal Regulations (Last Updated: May 6, 2024) |
 |
Title 42 - Public Health |
|
Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
|
SubChapter B - Medicare Program |
|
Part 405 - Federal Health Insurance for the Aged and Disabled |
|
Subpart I - Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B) |
|
Medicare Appeals Council Review |
§ 405.1106 - Where a request for review or escalation may be filed.
-
§ 405.1106 Where a request for review or escalation may be filed.
(a) When a request for a MAC Council review is filed after an ALJ or attorney adjudicator has issued a decision or dismissal, the request for review must be filed with the entity specified in the notice of the ALJ's or attorney adjudicator's action. The appellant must also send a copy of the request for review to the other parties to the ALJ or attorney adjudicator decision or dismissal who received a copy notice of the hearing decision under § 405.1046(a) or a copy of the notice of dismissal under § 405. 1052(b). Failure to copy the other parties tolls the MACCouncil's adjudication deadline set forth in § 405.1100 until all parties to the hearing ALJ or attorney adjudicator decision or dismissal receive notice of the request for MAC Council review. If the request for review is timely filed with an entity other than the entity specified in the notice of the ALJ's or attorney adjudicator's action, the MACCouncil's adjudication period to conduct a review begins on the date the request for review is received by the entity specified in the notice of the ALJ's or attorney adjudicator's action. Upon receipt of a request for review from an entity other than the entity specified in the notice of the ALJ's or attorney adjudicator's action, the MAC Council sends written notice to the appellant of the date of receipt of the request and commencement of the adjudication timeframe.
(b) If an appellant files a request to escalate an appeal to the MAC Council level because the ALJ or attorney adjudicator has not completed his or her action on the request for hearing within the an applicable adjudication deadline period under § 405.1016, the request for escalation must be filed with both the ALJ OMHA and the MAC. The appellant must also send a copy of the request for escalation to the other parties who were sent a copy of the QIC reconsideration. Failure to copy the other parties tolls the MACCouncil's adjudication deadline set forth in § 405.1100 until all parties to the hearing who were sent a copy of the QIC reconsideration receive notice of the request for MAC reviewescalation. In a case that has been escalated from the ALJOMHA, the MACCouncil's 180 calendar day period to issue a final decision, dismissal order, or remand order begins on the date the request for escalation is received by the MACCouncil.