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FEDERAL · 42 CFR

Part 426 — Review of National Coverage Determinations and Local Coverage Determinations

82 sections · Title 42: Public Health

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