42 C.F.R. § 423.634 Reopening and revising determinations and decisions.
Title 42 - Public Health
(a) A coverage determination or redetermination made by a Part D plan sponsor, a reconsideration made by the independent review entity specified in §423.600, or the decision of an ALJ or the MAC that is otherwise final and binding may be reopened and revised by the entity that made the determination or decision, under the rules in part 422, subpart M of this chapter. (b) The filing of a request for reopening does not relieve the Part D plan sponsor of its obligation to make payment or provide benefits as specified in §423.636 or §423.638. (c) Once an entity issues a revised determination or decision, the revisions made by the decision may be appealed. (d) A decision not to reopen by the Part D plan sponsor or any other entity is not subject to review.
Title 42: Public Health
PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
Subpart M—Grievances, Coverage Determinations, and Appeals
§ 423.634 Reopening and revising determinations and decisions.
