Regulations last checked for updates: Oct 19, 2024

Title 42 - Public Health last revised: Oct 15, 2024
§ 418.311 - Administrative appeals.

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.

[74 FR 39414, Aug. 6, 2009, as amended at 78 FR 48281, Aug. 7, 2013]
authority: 42 U.S.C. 1302 and 1395hh
source: 48 FR 56026, Dec. 16, 1983, unless otherwise noted.
cite as: 42 CFR 418.311