42 C.F.R. § 405.1034 When an ALJ may remand a case to the QIC.
Title 42 - Public Health
(a) General. If an ALJ believes that the written record is missing information that is essential to resolving the issues on appeal and that information can be provided only by CMS or its contractors, then the ALJ may either: (1) Remand the case to the QIC that issued the reconsideration or (2) Retain jurisdiction of the case and request that the contractor forward the missing information to the appropriate hearing office. (b) ALJ remands a case to a QIC. Consistent with §405.1004 (b), the ALJ will remand a case to the appropriate QIC if the ALJ determines that a QIC's dismissal of a request for reconsideration was in error. (c) Relationship to local and national coverage determination appeals process. (1) The ALJ remands an appeal to the QIC that made the reconsideration if the appellant is entitled to relief pursuant to 42 CFR 426.460(b)(1), 426.488(b), or 426.560(b)(1). (2) Unless the appellant is entitled to relief pursuant to 42 CFR 426.460(b)(1), 426.488(b), or 426.560(b)(1), the ALJ applies the LCD or NCD in place on the date the item or service was provided.
Title 42: Public Health
PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
Subpart I—Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)
ALJ Hearings
§ 405.1034 When an ALJ may remand a case to the QIC.
