Page:United States Statutes at Large Volume 114 Part 5.djvu/584

 114 STAT. 2763A-544 PUBLIC LAW 106-554—APPENDIX F "(B) DEFINITION OF NATIONAL COVERAGE DETERMINA- TION.—For purposes of this section, the term 'national coverage determination' means a determination by the Secretary with respect to whether or not a particular item or service is covered nationally under this title, but does not include a determination of what code, if any, is assigned to a particular item or service covered under this title or a determination with respect to the amount of payment made for a particular item or service so covered. " (2) LOCAL COVERAGE DETERMINATION. — "(A) IN GENERAL.— Review of any local coverage determination shall be subject to the following limitations: "(i) Upon the filing of a complaint by an aggrieved party, such a determination shall be reviewed by an administrative law judge of the Social Security Administration. The administrative law judge— "(I) shall review the record and shall permit discovery and the taking of evidence to evaluate the reasonableness of the determination, if the administrative law judge determines that the record is incomplete or lacks adequate information to support the validity of the determination; "(II) may, as appropriate, consult with appropriate scientific and clinical experts; and "(III) shall defer only to the reasonable findings of fact, reasonable interpretations of law, and reasonable applications of fact to law by the Secretary. "(ii) Upon the filing of a complaint by an aggrieved party, a decision of an administrative law judge under clause (i) shall be reviewed by the Departmental Appeals Board of the Department of Health and Human Services. "(iii) The Secretary shall implement a decision of the administrative law judge or the Departmental Appeals Board within 30 days of receipt of such decision. "(iv) A decision of the Departmental Appeals Board constitutes a final agency action and is subject to judicial review. " (B) DEFINITION OF LOCAL COVERAGE DETERMINA- TION. —For purposes of this section, the term 'local coverage determination' means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an intermediary- or carrier-wide basis under such parts, in accordance with section 1862(a)(1)(A). "(3) No MATERIAL ISSUES OF FACT IN DISPUTE. —In the case of a determination that may otherwise be subject to review under paragraph (l)(A)(iii) or paragraph (2)(A)(i), where the moving party alleges that— "(A) there are no material issues of fact in dispute, and "(B) the only issue of law is the constitutionality of a provision of this title, or that a regulation, determination, or ruling by the Secretary is invalid,

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