42 CFR §426.431
Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
- (a)Required steps. To review the provision(s) listed in the aggrieved party's complaint based on the reasonableness standard, an ALJ must:
- (1)Confine the LCD review to the provision(s) of the LCD raised in the aggrieved party's complaint.
- (2)Conduct a hearing, unless the matter can be decided on the written record.
- (3)Close the LCD review record to the taking of evidence.
- (4)Treat as precedential any previous Board decision under § 426.482 that involves the same LCD provison(s), same specific issue and facts in question, and the same clinical conditions.
- (5)Issue a decision as described in § 426.447.
- (b)Optional steps. The ALJ may do the following to apply the reasonableness standard to the provision(s) listed in the aggrieved party's complaint:
- (c)Authority for ALJs in LCD reviews when applying the reasonableness standard. In applying the reasonableness standard to a provision (or provisions) of an LCD, the ALJ must follow all applicable laws, regulations, rulings, and NCDs.