42 C.F.R. § 405.1835 Right to Board hearing.
Title 42 - Public Health
(a) Criteria. The provider (but no other individual, entity, or party) has a right to a hearing before the Board about any matter designated in §405.1801(a)(1), if: (1) An intermediary determination has been made with respect to the provider; and (2) The provider has filed a written request for a hearing before the Board under the provisions described in §405.1841(a)(1); and (3) The amount in controversy (as determined in §405.1839(a)) is $10,000 or more. (b) Prospective payment exceptions. Except with respect to matters for which administrative or judicial review is not permitted as specified in §405.1804, hospitals that are paid under the prospective payment system are entitled to hearings before the Board under this section if they otherwise meet the criteria described in paragraph (a) of this section. (c) Right to hearing based on late intermediary determination about reasonable cost. Notwithstanding the provisions of paragraph (a)(1) of this section, the provider also has a right to a hearing before the Board if an intermediary's determination concerning the amount of reasonable cost reimbursement due a provider is not rendered within 12 months after receipt by the intermediary of a provider's perfected cost report or amended cost report (as permitted or as required to furnish sufficient data for purposes of making such determination—see §405.1803(a)) provided such delay was not occasioned by the fault of the provider. [48 FR 39835, Sept. 1, 1983]
Title 42: Public Health
PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
Subpart R—Provider Reimbursement Determinations and Appeals
§ 405.1835 Right to Board hearing.
