Office of the Attorney Advisor (OAA)

Under Section 1878 of the Social Security Act and the regulations at 42 CFR 405.1875, the Administrator of the Centers for Medicare & Medicaid Services (CMS) has the authority to review decisions rendered by the Provider Reimbursement Review Board and to issue final agency decisions for the Secretary of the Department of Health and Human Services (HHS).  This authority has also been delegated to the Deputy Administrator of CMS.

The Administrator has the authority, either on his or her own motion or at the request of a party or CMS, to review a Board decision.  This review authority includes a decision under 42 CFR 405.1873 concerning the Board's jurisdiction to grant a hearing.

When the Administrator decides to review a Board decision, the Administrator has 60 days from the date of the provider's receipt of the Board's decision in which to reverse, affirm, or modify the decision. In addition, the Administrator may remand a case to the Board for further proceedings within the 60-day statutory timeframe.  The procedures and criteria for Board determination and appeals are located at 42 CFR 405.1802, et seq.  The rules relating specifically to the Administrator's review are found at 42 CFR 405.1875.