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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 and ALJ and Attorney Adjudicator Decisions, Council Review, and Judicial Review |
§ 423.2048 - The effect of an ALJ's or attorney adjudicator's decision.
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§ 423.2048 The effect of an ALJ's decision.
or attorney adjudicator's decision.
unless -(a) The decision of the ALJ or attorney adjudicator on a request for hearing is binding
bunless—
a(
MAC1) An enrollee requests a review of the decision by the
MACCouncil within the stated time period or the
MACCouncil reviews the decision issued by an ALJ or attorney adjudicator under the procedures set forth in § 423.2110, and the
Council issues a final decision or remand order;
(
MAC2) The decision is reopened and revised by an ALJ or attorney adjudicator or the
cCouncil under the procedures explained in § 423.1980;
(
d3) The expedited access to judicial review process at § 423.1990 is used;
(
MAC4) The ALJ's or attorney adjudicator's decision is a recommended decision directed to the
MACCouncil and the
eCouncil issues a decision; or
(
District Court5) In a case remanded by a Federal
MACdistrict court, the
MACCouncil assumes jurisdiction under the procedures in § 423.2138 and the
Council issues a decision.
(b) The decision of the ALJ or attorney adjudicator on a request for review of an IRE dismissal is binding on the enrollee unless the decision is reopened and revised by the ALJ or attorney adjudicator under the procedures explained in § 423.1980.
[82 FR 5135, Jan. 17, 2017]