US · guidance
CMS Pub. 100-04, ch. 29, § 340.1
Recommending Agency Referral of OMHA Decisions or Dismissals
CMS may refer a case to the Appeals Council for it to consider under its own motion review
authority within 60 days after the date of the ALJ hearing or attorney adjudicator decision or
dismissal. This is known as an “agency referral”. The Appeals Council may adopt, modify,
or reverse OMHA’s decision, may remand the case to an ALJ or attorney adjudicator for
further proceedings, or may dismiss an agency referral request. For OMHA decisions issued
by OMHA ALJs and attorney adjudicators, the AdQIC will be responsible for reviewing ALJ
and attorney adjudicator decisions and determining whether an agency referral is appropriate.
During the effectuation of an ALJ or attorney adjudicator decision, if the MAC’s medical
director disagrees with the decision and wishes to discuss the decision for potential referral to
the Appeals Council, the medical director shall contact the AdQIC.
History
(Rev. 4278., Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
87887785586b32bd96d3dbc5c25e3198ad1b518690d41bca8d6df75010fec1b1
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