42 C.F.R. § 405.1108 MAC actions when request for review or escalation is filed.
Title 42 - Public Health
(a) Except as specified in paragraphs (c) and (d) of this section, when a party requests that the MAC review an ALJ's decision, the MAC will review the ALJ's decision de novo. The party requesting review does not have a right to a hearing before the MAC. The MAC will consider all of the evidence in the administrative record. Upon completion of its review, the MAC may adopt, modify, or reverse the ALJ's decision or remand the case to an ALJ for further proceedings. (b) When a party requests that the MAC review an ALJ's dismissal, the MAC may deny review or vacate the dismissal and remand the case to the ALJ for further proceedings. (c) The MAC will dismiss a request for review when the party requesting review does not have a right to a review by the MAC, or will dismiss the request for a hearing for any reason that the ALJ could have dismissed the request for hearing. (d) When an appellant requests escalation of a case from the ALJ level to the MAC, the MAC may take any of the following actions: (1) Issue a decision based on the record constructed at the QIC and any additional evidence, including oral testimony, entered in the record by the ALJ before the case was escalated. (2) Conduct any additional proceedings, including a hearing, that the MAC determines are necessary to issue a decision. (3) Remand the case to an ALJ for further proceedings, including a hearing. (4) Dismiss the request for MAC review because the appellant does not have the right to escalate the appeal. (5) Dismiss the request for a hearing for any reason that the ALJ could have dismissed the request.
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
§ 405.1108 MAC actions when request for review or escalation is filed.
