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Electronic Code of Federal Regulations

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e-CFR Data is current as of December 16, 2014

Title 42Chapter IVSubchapter BPart 426


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER B—MEDICARE PROGRAM (CONTINUED)

PART 426—REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS

rule

Subpart A—GENERAL PROVISIONS

§426.100
Basis and scope.
§426.110
Definitions.
§426.120
Calculation of deadlines.
§426.130
Party submissions.
rule

Subpart B—[RESERVED]

rule

Subpart C—GENERAL PROVISIONS FOR THE REVIEW OF LCDS AND NCDS

§426.300
Review of LCDs, NCDs, and deemed NCDs.
§426.310
LCD and NCD reviews and individual claim appeals.
§426.320
Who may challenge an LCD or NCD.
§426.325
What may be challenged.
§426.330
Burden of proof.
§426.340
Procedures for review of new evidence.
rule

Subpart D—REVIEW OF AN LCD

§426.400
Procedure for filing an acceptable complaint concerning a provision (or provisions) of an LCD.
§426.403
Submitting new evidence once an acceptable complaint is filed.
§426.405
Authority of the ALJ.
§426.406
Ex parte contacts.
§426.410
Docketing and evaluating the acceptability of LCD complaints.
§426.415
CMS' role in the LCD review.
§426.416
Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review.
§426.417
Contractor's statement regarding new evidence.
§426.418
LCD record furnished to aggrieved party.
§426.419
LCD record furnished to the ALJ.
§426.420
Retiring or revising an LCD under review.
§426.423
Withdrawing a complaint regarding an LCD under review.
§426.425
LCD review.
§426.431
ALJ's review of the LCD to apply the reasonableness standard.
§426.432
Discovery.
§426.435
Subpoenas.
§426.440
Evidence.
§426.444
Dismissals for cause.
§426.445
Witness fees.
§426.446
Record of hearing.
§426.447
Issuance and notification of an ALJ's decision.
§426.450
Mandatory provisions of an ALJ's decision.
§426.455
Prohibited provisions of an ALJ's decision.
§426.457
Optional provisions of an ALJ's decision.
§426.458
ALJ's LCD review record.
§426.460
Effect of an ALJ's decision.
§426.462
Notice of an ALJ's decision.
§426.463
Future new or revised LCDs.
§426.465
Appealing part or all of an ALJ's decision.
§426.468
Decision to not appeal an ALJ's decision.
§426.470
Board's role in docketing and evaluating the acceptability of appeals of ALJ decisions.
§426.476
Board review of an ALJ's decision.
§426.478
Retiring or revising an LCD during the Board's review of an ALJ's decision.
§426.480
Withdrawing an appeal of an ALJ's decision.
§426.482
Issuance and notification of a Board decision.
§426.484
Mandatory provisions of a Board decision.
§426.486
Prohibited provisions of a Board decision.
§426.487
Board's record on appeal of an ALJ's decision.
§426.488
Effect of a Board decision.
§426.489
Board remands.
§426.490
Board decision.
rule

Subpart E—REVIEW OF AN NCD

§426.500
Procedure for filing an acceptable complaint concerning a provision (or provisions) of an NCD.
§426.503
Submitting new evidence once an acceptable complaint has been filed.
§426.505
Authority of the Board.
§426.506
Ex parte contacts.
§426.510
Docketing and evaluating the acceptability of NCD complaints.
§426.513
Participation as amicus curiae.
§426.515
CMS' role in making the NCD record available.
§426.516
Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.
§426.517
CMS' statement regarding new evidence.
§426.518
NCD record furnished to the aggrieved party.
§426.519
NCD record furnished to the Board.
§426.520
Withdrawing an NCD under review or issuing a revised or reconsidered NCD.
§426.523
Withdrawing a complaint regarding an NCD under review.
§426.525
NCD review.
§426.531
Board's review of the NCD to apply the reasonableness standard.
§426.532
Discovery.
§426.535
Subpoenas.
§426.540
Evidence.
§426.544
Dismissals for cause.
§426.545
Witness fees.
§426.546
Record of hearing.
§426.547
Issuance, notification, and posting of a Board's decision.
§426.550
Mandatory provisions of the Board's decision.
§426.555
Prohibited provisions of the Board's decision.
§426.557
Optional provisions of the Board's decision.
§426.560
Effect of the Board's decision.
§426.562
Notice of the Board's decision.
§426.563
Future new or revised or reconsidered NCDs.
§426.565
Board's role in making an LCD or NCD review record available.
§426.566
Board decision.
§426.587
Record for appeal of a Board NCD decision.


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