§ 405.1100 - Medicare Appeals Council review: General.

§ 405.1100 Medicare Appeals Council review: General.

Cross Reference

Link to an amendment published at 82 FR 5122, Jan. 17, 2017.

(a) The appellant or any other party to the hearing an ALJ's or attorney adjudicator's decision or dismissal may request that the MAC Council review an the ALJ's or attorney adjudicator's decision or dismissal.

(b) Under circumstances set forth in §§ 405.11041016 and 405.1108, the appellant may request that a case be escalated to the MAC Council for a decision even if the ALJ or attorney adjudicator has not issued a decision, dismissal, or dismissal remand in his or her case.

(c) When the MAC Council reviews an ALJ's or attorney adjudicator's decision, it undertakes a de novo review. The MAC Council issues a final decision or dismissal order or remands a case to the ALJ or attorney adjudicator within 90 calendar days of receipt of the appellant's request for review, unless the 90 calendar day period is extended as provided in this subpart.

(d) When deciding an appeal that was escalated from the ALJ OMHA level to the MACCouncil, the MAC Council will issue a final decision or dismissal order or remand the case to the OMHA Chief ALJ within 180 calendar days of receipt of the appellant's request for escalation, unless the 180 calendar day period is extended as provided in this subpart.

[70 82 FR 114725122, MarJan. 8, 2005, as amended at 74 FR 65336, Dec. 9, 200917, 2017]