Fifth Level of Appeal: Judicial Review in Federal District Court
Any party that is dissatisfied with the Medicare Appeals Council’s (the Council) decision may request review in Federal court. If the adjudication period for the Council to complete its review has elapsed and the Council is unable to issue a decision, dismissal, or remand the case to OMHA, the appellant party has the opportunity to escalate the appeal to Federal court.
Requesting Federal Court Review
A party may file an action in a Federal district court within 60 calendar days after the date it receives notice of the Council's decision. The notice of the Council’s decision is presumed to be received 5 days after the date on the notice, unless there is evidence to the contrary.
In order to request judicial review in Federal court, the amount remaining in controversy must meet the threshold requirement. This amount is recalculated each year and may change. For calendar year 2019, the amount in controversy is $1,630. For calendar year 2020, the amount in controversy rises to $1,670. To view the Amount in Controversy Federal Register notices, see the "Related Links" section below.
If the Council does not issue a decision or remand the case to an ALJ or attorney adjudicator within the adjudication period (factoring in any appropriate time extensions), the appellant may request that the appeal be escalated to Federal district court. Contact information for the Council can be found at: https://www.hhs.gov/about/agencies/dab/different-appeals-at-dab/appeals-to-council/index.html. Upon receipt of a request for escalation, the Council may issue a decision, dismissal, or remand the case to an ALJ or attorney adjudicator within 5 days of receipt of the request, or acknowledge receipt of the request for escalation and confirm that it is not able to issue a decision, dismissal, or remand order within the statutory time frame. The date of receipt of the Council's notice that it is not able to issue a decision within the statutory timeframe shall be presumed to be 5 calendar days after the date on the notice, unless there is evidence to the contrary. A party may file an action in a Federal district court within 60 calendar days after the date it receives the Council's notice that the Council is not able to issue a final decision, dismissal order, or remand order unless the party is appealing an ALJ or attorney adjudicator dismissal.
The Council's decision or notice that the Council is not able to issue a final decision will contain information about the procedures for requesting judicial review. Refer to 42 CFR 405.1136 for more information on filing a civil action in Federal district court.