42 CFR §488.211

1. (a)The hearing officer's decision is final unless the Administrator, within 30 days of the hearing officer's decision, chooses to review that decision.
2. (b)The Administrator may accept, reject or modify the hearing officer's findings.
3. (c)Should the Administrator choose to review the hearing officer's decision, the Administrator will issue a final reconsideration determination to the accreditation organization or State laboratory program on the basis of the hearing officer's findings and recommendations and other relevant information.
4. (d)The reconsideration determination of the Administrator is final.
5. (e)A final reconsideration determination against an accreditation organization or State laboratory program will be published by CMS in the Federal Register.