42 CFR §498.74

1. (a)Timing, basis and content. As soon as practical after the close of the hearing, the ALJ issues a written decision in the case. The decision is based on the evidence of record and contains separate numbered findings of fact and conclusions of law.
2. (b)Notice and effect. A copy of the decision is mailed to the parties and is binding on them unless—
   1. (1)A party requests review by the Departmental Appeals Board within the time period specified in § 498.82, and the Board reviews the case;
   2. (2)The Departmental Appeals Board denies the request for review and the party seeks judicial review by filing an action in a United States District Court or, in the case of a civil money penalty, in a United States Court of Appeals;
   3. (3)The decision is revised by an ALJ or the Departmental Appeals Board; or
   4. (4)The decision is a recommended decision directed to the Board.