42 CFR 418.311
§ 418.311 Administrative appeals.
United States · 42 CFR — Public Health · Status: effective
Cite this
- Citation
- 42 CFR 418.311, § 418.311 Administrative appeals, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/204374
- Permanent ID
ys:prov:204374@1- SHA-256
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Full text
A hospice that believes its payments have not been properly determined in accordance with these regulations may request a review from the intermediary or the Provider Reimbursement Review Board (PRRB) if the amount in controversy is at least $1,000 or $10,000, respectively. In such a case, the procedure in 42 CFR part 405, subpart R, will be followed to the extent that it is applicable. The PRRB, subject to review by the Secretary under § 405.1875 of this chapter, shall have the authority to determine the issues raised. The methods and standards for the calculation of the statutorily defined payment rates by CMS are not subject to appeal.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.