42 C.F.R. PART 426--REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS
TITLE 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B--MEDICARE PROGRAM
PART 426--REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS
Subpart A--GENERAL PROVISIONS
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| Calculation of deadlines.
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Subpart B--[RESERVED]
Subpart C--GENERAL PROVISIONS FOR THE REVIEW OF LCDS AND NCDS
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| Review of LCDs, NCDs, and deemed NCDs.
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| LCD and NCD reviews and individual claim appeals.
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| Who may challenge an LCD or NCD.
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| Procedures for review of new evidence.
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Subpart D--REVIEW OF AN LCD
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| Procedure for filing an acceptable complaint concerning a provision (or provisions) of an LCD.
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| Submitting new evidence once an acceptable complaint is filed.
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| Docketing and evaluating the acceptability of LCD complaints.
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| CMS' role in the LCD review.
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| Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review.
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| Contractor's statement regarding new evidence.
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| LCD record furnished to aggrieved party.
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| LCD record furnished to the ALJ.
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| Retiring or revising an LCD under review.
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| Withdrawing a complaint regarding an LCD under review.
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| ALJ's review of the LCD to apply the reasonableness standard.
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| Issuance and notification of an ALJ's decision.
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| Mandatory provisions of an ALJ's decision.
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| Prohibited provisions of an ALJ's decision.
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| Optional provisions of an ALJ's decision.
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| Effect of an ALJ's decision.
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| Notice of an ALJ's decision.
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| Future new or revised LCDs.
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| Appealing part or all of an ALJ's decision.
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| Decision to not appeal an ALJ's decision.
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| Board's role in docketing and evaluating the acceptability of appeals of ALJ decisions.
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| Board review of an ALJ's decision.
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| Retiring or revising an LCD during the Board's review of an ALJ's decision.
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| Withdrawing an appeal of an ALJ's decision.
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| Issuance and notification of a Board decision.
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| Mandatory provisions of a Board decision.
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| Prohibited provisions of a Board decision.
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| Board's record on appeal of an ALJ's decision.
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| Effect of a Board decision.
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Subpart E--REVIEW OF AN NCD
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| Procedure for filing an acceptable complaint concerning a provision (or provisions) of an NCD.
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| Submitting new evidence once an acceptable complaint has been filed.
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| Docketing and evaluating the acceptability of NCD complaints.
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| CMS' role in making the NCD record available.
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| Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.
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| CMS' statement regarding new evidence.
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| NCD record furnished to the aggrieved party.
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| NCD record furnished to the Board.
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| Withdrawing an NCD under review or issuing a revised or reconsidered NCD.
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| Withdrawing a complaint regarding an NCD under review.
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| Board's review of the NCD to apply the reasonableness standard.
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| Issuance, notification, and posting of a Board's decision.
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| Mandatory provisions of the Board's decision.
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| Prohibited provisions of the Board's decision.
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| Optional provisions of the Board's decision.
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| Effect of the Board's decision.
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| Notice of the Board's decision.
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| Future new or revised or reconsidered NCDs.
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| Board's role in making an LCD or NCD review record available.
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| Record for appeal of a Board NCD decision.
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