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Title 42, Part 426 — Review of National Coverage Determinations and Local Coverage Determinations

82 sections

Section 426.100
Basis and scope.
Section 426.110
Definitions.
Section 426.120
Calculation of deadlines.
Section 426.130
Party submissions.
Section 426.300
Review of LCDs, NCDs, and deemed NCDs.
Section 426.310
LCD and NCD reviews and individual claim appeals.
Section 426.320
Who may challenge an LCD or NCD.
Section 426.325
What may be challenged.
Section 426.330
Burden of proof.
Section 426.340
Procedures for review of new evidence.
Section 426.400
Procedure for filing an acceptable complaint concerning a provision (or provisions) of an LCD.
Section 426.403
Submitting new evidence once an acceptable complaint is filed.
Section 426.405
Authority of the ALJ.
Section 426.406
contacts.
Section 426.410
Docketing and evaluating the acceptability of LCD complaints.
Section 426.415
CMS' role in the LCD review.
Section 426.416
Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review.
Section 426.417
Contractor's statement regarding new evidence.
Section 426.418
LCD record furnished to aggrieved party.
Section 426.419
LCD record furnished to the ALJ.
Section 426.420
Retiring or revising an LCD under review.
Section 426.423
Withdrawing a complaint regarding an LCD under review.
Section 426.425
LCD review.
Section 426.431
ALJ's review of the LCD to apply the reasonableness standard.
Section 426.432
Discovery.
Section 426.435
Subpoenas.
Section 426.440
Evidence.
Section 426.444
Dismissals for cause.
Section 426.445
Witness fees.
Section 426.446
Record of hearing.
Section 426.447
Issuance and notification of an ALJ's decision.
Section 426.450
Mandatory provisions of an ALJ's decision.
Section 426.455
Prohibited provisions of an ALJ's decision.
Section 426.457
Optional provisions of an ALJ's decision.
Section 426.458
ALJ's LCD review record.
Section 426.460
Effect of an ALJ's decision.
Section 426.462
Notice of an ALJ's decision.
Section 426.463
Future new or revised LCDs.
Section 426.465
Appealing part or all of an ALJ's decision.
Section 426.468
Decision to not appeal an ALJ's decision.
Section 426.470
Board's role in docketing and evaluating the acceptability of appeals of ALJ decisions.
Section 426.476
Board review of an ALJ's decision.
Section 426.478
Retiring or revising an LCD during the Board's review of an ALJ's decision.
Section 426.480
Withdrawing an appeal of an ALJ's decision.
Section 426.482
Issuance and notification of a Board decision.
Section 426.484
Mandatory provisions of a Board decision.
Section 426.486
Prohibited provisions of a Board decision.
Section 426.487
Board's record on appeal of an ALJ's decision.
Section 426.488
Effect of a Board decision.
Section 426.489
Board remands.
Section 426.490
Board decision.
Section 426.500
Procedure for filing an acceptable complaint concerning a provision (or provisions) of an NCD.
Section 426.503
Submitting new evidence once an acceptable complaint has been filed.
Section 426.505
Authority of the Board.
Section 426.506
contacts.
Section 426.510
Docketing and evaluating the acceptability of NCD complaints.
Section 426.513
Participation as
Section 426.515
CMS' role in making the NCD record available.
Section 426.516
Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.
Section 426.517
CMS' statement regarding new evidence.
Section 426.518
NCD record furnished to the aggrieved party.
Section 426.519
NCD record furnished to the Board.
Section 426.520
Withdrawing an NCD under review or issuing a revised or reconsidered NCD.
Section 426.523
Withdrawing a complaint regarding an NCD under review.
Section 426.525
NCD review.
Section 426.531
Board's review of the NCD to apply the reasonableness standard.
Section 426.532
Discovery.
Section 426.535
Subpoenas.
Section 426.540
Evidence.
Section 426.544
Dismissals for cause.
Section 426.545
Witness fees.
Section 426.546
Record of hearing.
Section 426.547
Issuance, notification, and posting of a Board's decision.
Section 426.550
Mandatory provisions of the Board's decision.
Section 426.555
Prohibited provisions of the Board's decision.
Section 426.557
Optional provisions of the Board's decision.
Section 426.560
Effect of the Board's decision.
Section 426.562
Notice of the Board's decision.
Section 426.563
Future new or revised or reconsidered NCDs.
Section 426.565
Board's role in making an LCD or NCD review record available.
Section 426.566
Board decision.
Section 426.587
Record for appeal of a Board NCD decision.