42 C.F.R. § 430.102 : Public Health — CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES — MEDICAL ASSISTANCE PROGRAMS — GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS — HEARINGS ON CONFORMITY OF STATE MEDICAID PLANS AND PRACTICE TO FEDERAL REQUIREMENTS — Decisions following hearing

(a) Administrator presides. If the presiding officer is the Administrator, he or she issues the hearing decision within 60 days after expiration of the period for submission of posthearing briefs.
(b) Administrator's designee presides. If the presiding officer is other than the Administrator, the procedure is as follows:
(1) Upon expiration of the period allowed for submission of posthearing briefs, the presiding officer certifies the entire record, including his or her recommended findings and proposed decision, to the Administrator. The Administrator serves a copy of the recommended findings and proposed decision upon all parties and amici, if any.
(2) Any party may, within 20 days, file with the Administrator exceptions to the recommended findings and proposed decision and a supporting brief or statement.
(3) The Administrator reviews the recommended decision and, within 60 days of its issuance, issues his or her own decision.
(c) Effect of Administrator's decision. The decision of the Administrator under this section is the final decision of the Secretary and constitutes "final agency action" within the meaning of 5 U.S.C. 704 and a "final determination" within the meaning of section 1116(a)(3) of the Act and §430.38. The Administrator's decision is promptly served on all parties and amici.

42 C.F.R. § 430.102