§ 423.1968 Scope
§ 423.1978 Reopening determinations and decisions
§ 423.1980 Reopening of coverage determinations, redeterminations, reconsiderations, decisions, and reviews
§ 423.1982 Notice of a revised determination or decision
§ 423.1984 Effect of a revised determination or decision
§ 423.1986 Good cause for reopening
§ 423.1990 Expedited access to judicial review
§ 423.2000 Hearing before an ALJ and decision by an ALJ or attorney adjudicator: General rule
§ 423.2002 Right to an ALJ hearing
§ 423.2004 Right to a review of IRE notice of dismissal
§ 423.2006 Amount in controversy required for an ALJ hearing and judicial review
§ 423.2008 Parties to the proceedings on a request for an ALJ hearing
§ 423.2010 When CMS, the IRE, or Part D plan sponsors may participate in the proceedings on a request for an ALJ hearing
§ 423.2014 Request for an ALJ hearing or a review of an IRE dismissal
§ 423.2016 Timeframes for deciding an appeal of an IRE reconsideration
§ 423.2018 Submitting evidence
§ 423.2020 Time and place for a hearing before an ALJ
§ 423.2022 Notice of a hearing before an ALJ
§ 423.2024 Objections to the issues
§ 423.2026 Disqualification of the ALJ or attorney adjudicator
§ 423.2030 ALJ hearing procedures
§ 423.2032 Issues before an ALJ or attorney adjudicator
§ 423.2034 Requesting information from the IRE
§ 423.2036 Description of an ALJ hearing process
§ 423.2038 Deciding a case without a hearing before an ALJ
§ 423.2040 Prehearing and posthearing conferences
§ 423.2042 The administrative record
§ 423.2044 Consolidated proceedings
§ 423.2046 Notice of an ALJ or attorney adjudicator decision
§ 423.2048 The effect of an ALJ’s or attorney adjudicator’s decision
§ 423.2050 Removal of a hearing request from OMHA to the Council
§ 423.2052 Dismissal of a request for a hearing before an ALJ or request for review of an IRE dismissal
§ 423.2054 Effect of dismissal of a request for a hearing or request for review of an IRE’s dismissal
§ 423.2056 Remands of requests for hearing and requests for review
§ 423.2058 Effect of a remand
§ 423.2062 Applicability of policies not binding on the ALJ and Council
§ 423.2063 Applicability of laws, regulations, CMS Rulings, and precedential decisions
§ 423.2100 Medicare Appeals Council review: general
§ 423.2102 Request for Council review when ALJ or attorney adjudicator issues decision or dismissal
§ 423.2106 Where a request for review may be filed
§ 423.2108 Council Actions when request for review is filed
§ 423.2110 Council reviews on its own motion
§ 423.2112 Content of request for review
§ 423.2114 Dismissal of request for review
§ 423.2116 Effect of dismissal of request for Council review or request for hearing
§ 423.2118 Obtaining evidence from the Council
§ 423.2120 Filing briefs with the Council
§ 423.2122 What evidence may be submitted to the Council
§ 423.2124 Oral argument
§ 423.2126 Case remanded by the Council
§ 423.2128 Action of the Council
§ 423.2130 Effect of the Council’s decision
§ 423.2134 Extension of time to file action in Federal District Court
§ 423.2136 Judicial review
§ 423.2138 Case remanded by a Federal District Court
§ 423.2140 Council Review of ALJ or attorney adjudicator decision in a case remanded by a Federal District Court

Terms Used In CFR > Title 42 > Chapter IV > Subchapter B > Part 423 > Subpart U - Reopening, Alj Hearings and Alj and Attorney Adjudicator Decisions, Council Review, and Judicial Review

  • ALJ: includes a member or members of the Departmental Appeals Board who are designated to conduct a hearing. See 42 CFR 423.1024
  • Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Continuance: Putting off of a hearing ot trial until a later time.
  • Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
  • Dismissal: The dropping of a case by the judge without further consideration or hearing. Source:
  • Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
  • Fraud: Intentional deception resulting in injury to another.
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Oral argument: An opportunity for lawyers to summarize their position before the court and also to answer the judges' questions.
  • Plaintiff: The person who files the complaint in a civil lawsuit.
  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
  • Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
  • Remand: When an appellate court sends a case back to a lower court for further proceedings.
  • Subpoena: A command to a witness to appear and give testimony.
  • Venue: The geographical location in which a case is tried.