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Code of Federal Regulations (Last Updated: July 5, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter B - Medicare Program |
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Part 423 - Voluntary Medicare Prescription Drug Benefit |
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Subpart U - Reopening, ALJ Hearings, MAC review, and Judicial Review |
§ 423.1982 - Notice of a revised determination or decision.
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§ 423.1982 Notice of a revised determination or decision.
(a) When adjudicators initiate reopenings. When any determination or decision is reopened and revised as provided in § 423.1980:
(1) The Part D plan sponsor, IRE, ALJ or attorney adjudicator, or the MAC Council must mail its revised determination or decision to the enrollee at his or her last known address.
(2) The IRE, ALJ or attorney adjudicator, or the MAC Council must mail its revised determination or decision to the Part D plan sponsor.
(3) An adverse revised determination or decision must state the rationale and basis for the reopening and revision and any right to appeal.
(b) Reopenings initiated at the request of an enrollee or a Part D plan sponsor.
(1) The Part D plan sponsor, IRE, ALJ or attorney adjudicator, or the MAC Council must mail its revised determination or decision to the enrollee at his or her last known address.
(2) The IRE, ALJ , or attorney adjudicator or the MAC Council must mail its revised determination or decision to the Part D plan sponsor.
(3) An adverse revised determination or decision must state the rationale and basis for the reopening and revision and any right to appeal.
[74 FR 65363, Dec. 9, 2009, as amended at 82 FR 5126, Jan. 17, 2017]