The U.S. Department of Health and Human Services (HHS) Office of Medicare Hearings and Appeals (OMHA) recently proposed changes to the Medicare appeals process to help reduce the backlog of pending appeals and streamline the process. The proposed regulatory changes are outlined in a Notice of Proposed Rulemaking (NPRM), which will be published in the Federal Register on July 5; in the meantime, the unpublished proposed rule is available.
HHS recently released a primer on the Medicare Appeals process [http://www.hhs.gov/omha/files/medicare-appeals-backlog.pdf]that describes its three-pronged strategy to address the backlog:
- Invest new resources at all levels of appeal to increase adjudication capacity and implement new strategies to alleviate the current backlog.
- Take administrative actions to reduce the number of pending appeals and encourage resolution of cases earlier in the process.
- Propose legislative reforms that provide additional funding and new authorities to address the appeals volume.
“The proposed regulatory changes that appear in the NPRM are the latest in a series of administrative actions designed to reduce the number of pending appeals and encourage resolution of cases earlier in the Medicare appeals process,” Nancy Griswold, OMHA chief law judge, wrote in an OMHA blog.
The proposed rule is part of the second prong of OMHA’s strategy. The following are among the proposed administrative actions:
- Expand the pool of available OMHA adjudicators.
- Increase decision-making consistency among the levels of appeal.
- Improve efficiency by streamlining the appeals process so less time is spent by adjudicators and parties on repetitive issues and procedural matters.
In addition to these administrative actions, the fiscal year 2017 President’s Budget requests additional funding to bring OMHA’s capacity for processing and resolving appeals in line with the current appeal volume. The budget request also includes a comprehensive legislative package aimed at helping HHS process a greater number of appeals and encouraging resolution of appeals earlier in the process before they reach the OMHA and the Departmental Appeals Board.
Public comments to the proposed rule must be received no later than 5 p.m. ET on August 29. Written comments may be sent to OMHA, HHS, Attention: HHS-2015-49, 5201 Leesburg Pike, Suite 1300, Falls Church, Virginia 22041. Electronic comments can be submitted under the Help tab at www.regulations.gov. Refer to “HHS-2015-49” at the top of your comments.
