(a) Required steps. To review the provision(s) listed in the aggrieved party's complaint based on the reasonableness standard, an ALJ must:
- (1) Confine the LCD review to the provision(s) of the LCD raised in the aggrieved party's complaint.
- (2) Conduct a hearing, unless the matter can be decided on the written record.
- (3) Close the LCD review record to the taking of evidence.
- (4) Treat as precedential any previous Board decision under § 426.482 that involves the same LCD provison(s), same specific issue and facts in question, and the same clinical conditions.
- (5) Issue a decision as described in § 426.447.
(b) Optional steps. The ALJ may do the following to apply the reasonableness standard to the provision(s) listed in the aggrieved party's complaint:
- (1) Consult with appropriate scientific or clinical experts concerning evidence.
- (2) Consider any previous ALJ decision made under § 426.447 regarding the same provision(s) of the LCD under review and for the same clinical conditions.
- (c) Authority for ALJs in LCD reviews when applying the reasonableness standard. In applying the reasonableness standard to a provision (or provisions) of an LCD, the ALJ must follow all applicable laws, regulations, rulings, and NCDs.