Section 20.600  Review and Reconsideration

a)         The applicant may request that CMS reconsider a certification denial.  CMS shall inform the applicant of the reconsideration decision within 60 days after receipt of the request for reconsideration.

b)         The applicant may request a review of an unfavorable reconsideration decision of CMS.  The applicant must submit this request in writing to CMS postmarked no later than 30 days after the applicant received the decision. The request must state why the applicant believes the decision is wrong, must address all points raised in the decision and must include any supportive documentation. Upon receipt of this request, CMS shall refer all documentation to the Committee for review.

c)         The Committee (see Section 20.20) shall consider any requested appeal reviews from CMS. CMS will attempt to schedule a Committee meeting within 30 days after receipt of the request for review.  The meeting may be held in Chicago or Springfield and CMS will notify the applicant at least 10 days prior to the meeting of the location, date and time.

d)         CMS shall provide each Committee member with a copy of the request for review, other relevant information and a response to the points raised in the request for review.  Each Committee member shall review the files prior to the meeting.

e)         The Committee Chair shall call the meeting to order, announce the matter at issue and explain the meeting procedures. The Chair shall briefly restate the reasons given for the decision for denial and open the floor to the applicant. The meeting shall proceed in an informal manner within these procedures.  All information obtained shall be considered.

f)         The applicant may make an opening statement, but must respond to each of the reasons for denial given in the decision.  The applicant may bring and question any witnesses.  The Committee may ask questions of the applicant, CMS or any other person present.  CMS may comment at any time. When the applicant is finished, CMS may call witnesses.  Both the applicant and CMS may make closing statements. Although the applicant may have an attorney or other representatives assisting at the meeting, the applicant must be present and respond to questions of the Committee.

g)         The Committee shall consider the information obtained at the meeting.  The Committee's decision will be based upon majority vote to be given at a Committee meeting or submitted individually to CMS, who shall record and report the vote.

h)         If the decision is favorable to the applicant, CMS will reverse its denial decision, notify the applicant, and place the applicant on the list of certified vendors.  If the decision is adverse to the applicant, CMS will notify the applicant accordingly, providing the Committee's reasons for supporting CMS' original denial decision.