42 CFR § 478.28 - Qualifications of a reconsideration reviewer.
---
identifier: "/us/cfr/t42/s478.28"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 478.28 - Qualifications of a reconsideration reviewer."
title_number: 42
title_name: "Public Health"
section_number: "478.28"
section_name: "Qualifications of a reconsideration reviewer."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "F"
subchapter_name: "QUALITY IMPROVEMENT ORGANIZATIONS"
part_number: "478"
part_name: "RECONSIDERATIONS AND APPEALS"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh)."
cfr_part: "478"
---
# 478.28 Qualifications of a reconsideration reviewer.
A reconsideration reviewer must be someone who is—
(a) Qualified under § 476.98 of this chapter to make an initial determination.
(b) Not the individual who made the initial denial determination.
(c) A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review.
[50 FR 15330, Apr. 17, 1985, as amended at 77 FR 68563, Nov. 15, 2012]