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Title 42: Public Health
CHAPTER IV: CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)
SUBCHAPTER B: MEDICARE PROGRAM
PART 422: MEDICARE ADVANTAGE PROGRAM
Subpart N: Medicare Contract Determinations and Appeals
422.660 - Right to a hearing, burden of proof, standard of proof, and standards of review.
(a) Right to a hearing. The following parties are entitled to a hearing:
(1) A contract applicant that has been determined to be unqualified to enter into a contract with CMS under Part C of Title XVIII of the Act in accordance with ? 422.501 and ? 422.502.
(2) An MA organization whose contract has been terminated under ? 422.510 of this part.
(3) An MA organization whose contract has not been renewed under ? 422.506 of this part.
(4) An MA organization who has had an intermediate sanction imposed in accordance with ? 422.752(a) through (b) of this part.
(b) Burden of proof, standard of proof, and standards of review at a hearing. (1) During a hearing to review a contract determination as described at ? 422.641(a) of this subpart, the applicant has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of ? 422.501 and ? 422.502 of this part.
(2) During a hearing to review a contract determination as described at ? 422.641(b) of this subpart, the MA organization has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of ? 422.506 of this part.
(3) During a hearing to review a contract determination as described at ? 422.641(c) of this subpart, the MA organization has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of ? 422.510 of this part.
(4) During a hearing to review the imposition of an intermediate sanction as described at ? 422.750 of this part, the MA organization has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of ? 422.752 of this part.
(c) Timing of favorable decisions. Notice of any decision favorable to the MA organization appealing a determination that it is not qualified to enter into a contract with CMS must be issued by September 1 for the contract in question to be effective on January 1 of the following year.
[75 FR 19813, Apr. 15, 2010]
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