TITLE 42 - PUBLIC HEALTH

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

SUBCHAPTER B - MEDICARE PROGRAM

PART 423 - VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT

subpart m - GRIEVANCES, COVERAGE DETERMINATIONS, AND APPEALS

423.612 - Request for an ALJ hearing.

  (a) How and where to file a request. The enrollee must file a written request for a hearing with the entity specified in the IRE's reconsideration notice.

  (b) When to file a request. Except when an ALJ extends the timeframe as provided in part 422, subpart M of this chapter, the enrollee must file a request for a hearing within 60 days of the date of the notice of an IRE reconsideration determination. The time and place for a hearing before an ALJ will be set in accordance with 405.1020 of this chapter.

  (c) Insufficient amount in controversy. (1) If a request for a hearing clearly shows that the amount in controversy is less than that required under 423.610, the ALJ dismisses the request.

  (2) If, after a hearing is initiated, the ALJ finds that the amount in controversy is less than the amount required under 423.610, the ALJ discontinues the hearing and does not rule on the substantive issues raised in the appeal.