TITLE 42 - PUBLIC HEALTH

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B - MEDICARE PROGRAM

PART 405 - FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED

subpart r - PROVIDER REIMBURSEMENT DETERMINATIONS AND APPEALS

405.1873 - Board's jurisdiction.

  (a) Board decides jurisdiction. The Board decides questions relating to its jurisdiction to grant a hearing, including (1) the timeliness of an intermediary determination (see 405.1835(c)), and (2) the right of a provider to a hearing before the Board when the amount in controversy is in issue (see 405.1835(a)(3) and 405.1837).

  (b) Matters not subject to board review. (1) The determination of a fiscal intermediary that no payment may be made under title XVIII of the Act for any expenses incurred for items and services furnished to an individual because such items and services are excluded from coverage pursuant to section 1862 of the Act, 42 U.S.C. 1395y (see subpart C of this part), may not be reviewed by the Board. (Such determination shall be reviewed only in accordance with the applicable provisions of subpart G or H of this part.) (2) The Board may not review certain matters affecting payments to hospitals under the prospective payment system as provided in 405.1804.

[48 FR 39836, Sept. 1, 1983]