42 C.F.R. § 405.1104 Request for MAC review when an ALJ does not issue a decision timely.
Title 42 - Public Health
(a) Requesting escalation. An appellant who files a timely request for hearing before an ALJ and whose appeal continues to be pending before the ALJ at the end of the applicable ALJ adjudication period under §405.1016 may request MAC review if— (1) The appellant files a written request with the ALJ to escalate the appeal to the MAC after the adjudication period has expired; and (2) The ALJ does not issue a final action or remand the case to the QIC within the later of 5 days of receiving the request for escalation or 5 days from the end of the applicable adjudication period set forth in §405.1016. (b) Escalation. (1) If the ALJ is not able to issue a final action or remand within the time period set forth in paragraph (a)(2) of this section, he or she sends notice to the appellant. (2) The notice acknowledges receipt of the request for escalation, and confirms that the ALJ is not able to issue a final action or remand order within the statutory time frame. (3) If the ALJ does not act on a request for escalation within the time period set forth in paragraph (a)(2) of this section or does not send the required notice to the appellant, the QIC decision becomes a final administrative decision for purposes of MAC review. (c) No escalation. If the ALJ's adjudication period set forth in §405.1016 expires, the case remains with the ALJ until a final action is issued or the appellant requests escalation to the MAC. [70 FR 11472, Mar. 8, 2005, as amended at 70 FR 37704, June 30, 2005]
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)
Medicare Appeals Council Review
§ 405.1104 Request for MAC review when an ALJ does not issue a decision timely.
