§ 423.2102 - Request for Council review when ALJ or attorney adjudicator issues decision or dismissal.

§ 423.2102 Request for MAC Council review when ALJ or attorney adjudicator issues decision or dismissal.

Cross Reference

Link to an amendment published at 82 FR 5137, Jan. 17, 2017.

(a)

(1) An enrollee to the ALJ hearing may request a MAC review Council review of a decision or dismissal issued by an ALJ or attorney adjudicator if the enrollee files a written request for a MAC Council review within 60 calendar days after receipt of the ALJ's or attorney adjudicator's written decision or dismissal.

(2) An enrollee may request that MAC Council review be expedited if the appeal involves an issue specified in § 423.566(b) but does not include solely a request for payment of Part D drugs already furnished.

(i) If an enrollee is requesting that the MAC Council review be expedited, the enrollee submits an oral or written request within 60 calendar days after the receipt of the ALJ's or attorney adjudicator's written decision or dismissal. A prescribing physician or other prescriber may provide oral or written support for an enrollee's request for expedited review.

(ii) The MAC Council must document all oral requests for expedited review in writing and maintain the documentation in the case files.

(3) For purposes of this section, the date of receipt of the ALJ's or attorney adjudicator's written decision or dismissal is presumed to be 5 calendar days after the date of the notice of the decision or dismissal, unless there is evidence to the contrary.

(4) The request is considered as filed on the date it is received by the entity specified in the notice of the ALJ's or attorney adjudicator's action.

(b) An enrollee requesting a review may ask that the time for filing a request for MAC Council review be extended if - if—

(1) The request for an extension of time is in writing or, for expedited reviews, in writing or oral. The MAC Council must document all oral requests in writing and maintain the documentation in the case file.

(2) The request explains why the request for review was not filed within the stated time period. If the MAC Council finds that there is good cause for missing the deadline, the time period will be extended. To determine whether good cause exists, the MAC Council uses the standards outlined at § 405.942(b)(2) and § 405.942(b)(3) of this chapter.

(c) An enrollee does not have the right to seek MAC Council review of an ALJ's or attorney adjudicator's remand to an IRE, or an ALJ's or attorney adjudicator's affirmation of an IRE's dismissal of a request for reconsideration, or dismissal of a request to review an IRE dismissal.

[82 FR 5137, Jan. 17, 2017]