42 CFR §405.1002
Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
- (a)A party to a QIC reconsideration has a right to a hearing before an ALJ if—
- (1)The party files a written request for an ALJ hearing within 60 calendar days after receipt of the notice of the QIC's reconsideration.
- (2)The party meets the amount in controversy requirements of § 405.1006.
- (3)For purposes of this section, the date of receipt of the reconsideration is presumed to be 5 calendar days after the date of the reconsideration, unless there is evidence to the contrary.
- (4)For purposes of meeting the 60 calendar day filing deadline, the request is considered as filed on the date it is received by the office specified in the QIC's reconsideration.
- (b)A party who files a timely appeal before a QIC and whose appeal continues to be pending before a QIC at the end of the period described in § 405.970 has a right to a hearing before an ALJ if—
- (1)The party files a written request with the QIC to escalate the appeal for a hearing before an ALJ after the period described in § 405.970(a) and (b) has expired and the party files the request in accordance with § 405.970(d);
- (2)The QIC does not issue a decision or dismissal order within 5 calendar days of receiving the request for escalation in accordance with § 405.970(e)(2); and
- (3)The party has an amount remaining in controversy specified in § 405.1006.