Regulations last checked for updates: Nov 24, 2024

Title 42 - Public Health last revised: Nov 19, 2024
§ 478.28 - Qualifications of a reconsideration reviewer.

A reconsideration reviewer must be someone who is—

(a) Qualified under § 476.98 of this chapter to make an initial determination.

(b) Not the individual who made the initial denial determination.

(c) A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review.

[50 FR 15330, Apr. 17, 1985, as amended at 77 FR 68563, Nov. 15, 2012]
authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh)
cite as: 42 CFR 478.28