US · guidance
CMS Pub. 100-16, ch. 14, § 40
Reopening of Contract Determination or Decision of a Hearing
Officer or the CMS Administrator
(Rev. 122, Issued: 05-27-16, Effective: 06-28-16, Implementation: 06-28-16)
A reopening is not an appeal right. It is an administrative procedure that permits
reexamination of an existing determination for a specific reason. If an applicant or MAO
believes it has a basis for a decision to be reopened, it may request that the decision-maker reopen the matter. The decision whether to act on such a request, however, is
committed to the decision-maker’s discretion, and is not subject to appeal or further
review of any kind. This policy is consistent with our general policies on reopening
decisions, as discussed in 42 CFR Part 405, Subpart R, Provider Reimbursement
Determinations and Appeals.
The notice of reopening and any revisions following the reopening is mailed to the parties
and specifies the reasons for revisions.
History
(Rev. 122, Issued: 05-27-16, Effective: 06-28-16, Implementation: 06-28-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
0eb07acf711484153ba2a7c24b53abc1e9236afb6b3fb28ab024d5b190d64c4d
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