42 CFR § 478.28
Qualifications of a reconsideration reviewer
June 11, 2020
A reconsideration reviewer must be someone who is—
(a) Qualified under §476.98 of this chapter to make an initial determination.
(b) Not the individual who made the initial denial determination.
(c) A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review.
[50 FR 15330, Apr. 17, 1985, as amended at 77 FR 68563, Nov. 15, 2012]
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