CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER B—MEDICARE PROGRAM (parts 405 to 426) > PART 422—MEDICARE ADVANTAGE PROGRAM > SUBPART M—Grievances, Organization Determinations and Appeals (§422.560 to §422.626) > 422.612—Judicial review.

422.612—Judicial review.

(a) Review of ALJ's decision. Any party, including the MA organization, may request judicial review (upon notifying the other parties) of an ALJ's decision if—
(1) The Board denied the party's request for review; and
(2) The amount in controversy meets the threshold requirement established annually by the Secretary.
(b) Review of MAC decision. Any party, including the MA organization, may request judicial review (upon notifying the other parties) of the MAC decision if it is the final decision of CMS and the amount in controversy meets the threshold established in paragraph (a)(2) of this section.
(c) How to request judicial review. In order to request judicial review, a party must file a civil action in a district court of the United States in accordance with section 205(g) of the Act. See part 405 of this chapter for a description of the procedures to follow in requesting judicial review.
[63 FR 35107, June 26, 1998; 63 FR 52614, Oct. 1, 1998, as amended at 65 FR 40331, June 29, 2000; 70 FR 4740, Jan. 28, 2005]