42 CFR 423.2048 - The effect of an ALJ's decision.
The decision of the ALJ is binding unless -
(a) An enrollee requests a review of the decision by the MAC within the stated time period or the MAC reviews the decision issued by an ALJ under the procedures set forth in § 423.2110, and the MAC issues a final decision or remand order;
(b) The decision is reopened and revised by an ALJ or the MAC under the procedures explained in § 423.1980;
(c) The expedited access to judicial review process at § 423.1990 is used;
(d) The ALJ's decision is a recommended decision directed to the MAC and the MAC issues a decision; or
(e) In a case remanded by a Federal District Court, the MAC assumes jurisdiction under the procedures in § 423.2138 and the MAC issues a decision.