§ 423.2042 - The administrative record.

§ 423.2042 The administrative record.

Cross Reference

Link to an amendment published at 82 FR 5134, Jan. 17, 2017.

(a) Creating the record.

(1) The ALJ OMHA makes a complete record of the evidence and administrative proceedings on the appealed matter, including the any prehearing and posthearing conference and hearing proceedings , if anythat were conducted.

(2) The record will include marked as exhibits, the appealed determinations and documents and other evidence used in making the decision under reviewappealed determinations and the ALJ's or attorney adjudicator's decision, including, but not limited to, medical records, written statements, certificates, reports, affidavits, and any other evidence the ALJ or attorney adjudicator admits. The record will also include any evidence excluded or not considered by the ALJ or attorney adjudicator, including but not limited to duplicative evidence submitted by the enrollee.

(3) An enrollee may review request and receive a copy of the record prior to or at the hearing, or, if a hearing is not held, at any time before the ALJ's notice of decision is issued.

(4) If a request for review is filed, the complete record, including any recording of the hearingprehearing and posthearing conference and hearing recordings, is forwarded to the MACCouncil.

(5) A typed transcription of the hearing is prepared if an enrollee seeks judicial review of the case in a Federal district court within the stated time period and all other jurisdictional criteria are met, unless, upon the Secretary's motion prior to the filing of an answer, the court remands the case.

(b) Requesting and receiving copies of the record.

(1) An While an appeal is pending at OMHA, an enrollee may request and receive a copy of all or part of the record from OMHA, including the exhibits listany index of the administrative record, documentary evidence, and a copy of the tape audio recording of the oral proceedings. The enrollee may be asked to pay the costs of providing these items.

(2) If an enrollee requests a copy of all or part of the record from OMHA or the ALJ or attorney adjudicator and an opportunity to comment on the record, any adjudication period that applies in accordance with § 423.2016 is extended by the time beginning with the ALJ's receipt of the request through the expiration of the time granted for the enrollee's response does not count toward the adjudication deadline. .

(3) If the enrollee requests a copy of all or part of the record and the record, including any audio recordings, contains information pertaining to an individual that the enrollee is not entitled to receive, such as personally identifiable information or protected health information, such portions of the record will not be furnished unless the enrollee obtains consent from the individual.

[82 FR 5134, Jan. 17, 2017]