(a) Right to a hearing. The following parties are entitled to a hearing:
(1) A contract applicant that has been determined to be unqualified to enter into a contract with CMS under Part C of Title XVIII of the Act in accordance with Secs. 422.501 and 422.502.
(2) An MA organization whose contract has been terminated in accordance with Sec. 422.510.
(3) An MA organization whose contract has not been renewed in accordance with Sec. 422.506.
(4) An MA organization who has had an intermediate sanction imposed in accordance with Sec. 422.752(a) through (b) of this part.
(5) An applicant that has been determined to be unqualified to offer a Specialized MA Plan for Special Needs Individuals.
(b) Burden of proof, standard of proof, and standards of review at a hearing. (1) During a hearing to review a contract determination as described at Sec. 422.641(a) of this subpart, the applicant has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of Secs. 422.501 and 422.502 of this part.
(1) During a hearing to review a contract determination as described at Sec. 422.641(a) of this subpart, the applicant has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of Secs. 422.501 and 422.502 of this part.
(2) During a hearing to review a contract determination as described at Sec. 422.641(b) of this subpart, the MA organization has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of Sec. 422.506 of this part.
(3) During a hearing to review a contract determination as described at Sec. 422.641(c) of this subpart, the MA organization has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of Sec. 422.510 of this part.
(4) During a hearing to review the imposition of an intermediate sanction as described at Sec. 422.750, the MA organization has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of Sec. 422.752(a) and (b).
(5) During a hearing to review a determination as described at Sec. 422.641(d) of this subpart, the applicant has the burden of proving by a preponderance of the evidence that CMS' determination was inconsistent with the requirements of Secs. 422.2; 422.4(a)(1)(iv); 422.101(f); 422.107, if applicable; and 422.152(g) of this part.
(c) Timing of favorable decisions. Notice of any decision favorable to the MA organization appealing a determination that it is not qualified to enter into a contract with CMS must be issued by September 1 for the contract in question to be effective on January 1 of the following year. [75 FR 19813, Apr. 15, 2010, as amended at 77 FR 22168, Apr. 12, 2012; 80 FR 7962, Feb. 12, 2015]