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If the Medicare Appeals Council (Appeals Council) issues an adverse decision or denies a request to review an Administrative Law Judge's decision, the enrollee or the enrollee's representative may request a review by a Federal District Court. An enrollee's prescriber may not request a Federal District Court review on an enrollee's behalf unless the prescriber is also the enrollee's representative. For more information about appointing a representative, see section 10.4 in Chapter 18 of the Prescription Drug Benefit Manual. You may view Chapter 18 of the Prescription Drug Benefit Manual by clicking on the link in the "Downloads" section below. How to Request a Review by a Federal District Court In order to request a review by a Federal District Court, the amount remaining in controversy must meet the threshold requirement. This amount may change each year. For calendar year 2011, the amount in controversy threshold is $1,300. For calendar year 2012, the amount in controversy will increase to $1,350. For more information about how the amount remaining in controversy is computed, see section 110 in Chapter 18 of the Prescription Drug Benefit Manual. You may view Chapter 18 of the Prescription Drug Benefit Manual by clicking on the link in the "Downloads" section below. The request must be filed with the proper Federal District Court within 60 calendar days from the date of the Appeals Council's decision notice. All requests must be made in writing. If the Appeals Council's decision is unfavorable, the decision will contain the information needed to file a request for review by a Federal District Court. For a description of the procedures an appellant must follow in requesting judicial review, see Title 42, Part 423, section 2130 through section 2140 of the Code of Federal Regulations (CFR). Click on the links in the "Related Links Outside CMS" section below.
Page Last Modified: 09/28/2011 9:14:40 AM
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