Office of Medicare Hearings and Appeals; Statement of Organization, Functions, and Delegations of Authority, 36386-36387 [05-12468]

Agencies

• Office of the Secretary
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 70, Number 120 (Thursday, June 23, 2005)]
[Notices]
[Pages 36386-36387]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-12468]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary


Office of Medicare Hearings and Appeals; Statement of 
Organization, Functions, and Delegations of Authority

    Part A. Office of the Secretary, of the Statement of Organization, 
Functions, and Delegations of Authority for the Department of Health 
and Human Services, Part A, as last amended at 69 FR 51679-51680, dated 
August 20, 2004, and Chapter AA, Immediate Office of the Secretary, as 
last amended at 69 FR 51679-51680, dated August 20, 2004, are being 
amended to establish a new Chapter AK, the Office of Medicare Hearings 
and Appeals (OMHA) within the Office of the Secretary. This new Chapter 
is being created as a result of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (MMA), under which the 
functions of Administrative Law Judges (ALJs) responsible for hearing 
cases under title XVIII of the Social Security Act (and related 
provisions in title XI of such Act) are transferred from the Social 
Security Administration to the Department of Health and Human Services. 
The changes are as follows:
    I. Under Part A, Chapter AA, Section AA, Section AA.10 
Organization, insert the following: ``Office of Medicare Hearings and 
Appeals (OMHA)''

[[Page 36387]]

    II. Under Part A, establish a new Chapter AK, ``Office of Medicare 
Hearings and Appeals (OMHA)'' to read as follows:

Section AK.00 Mission

Section AK.10 Organization

Section AK.20 Functions

    Section AK.00 Mission. The Office of Medicare Hearings and Appeals 
(OMHA), under direct delegation from the Secretary of the Department of 
Health and Human Services, administers the nationwide hearings and 
appeals programs for the Medicare Program. The ALJs within the Office 
of Medicare Hearings and Appeals issue the final decisions of the 
Secretary, except for decisions reviewed by the Medicare Appeals 
Council, on hihgly complex appealed determinations involving Medicare 
Part A, B, C, and D. OMHA provides the basic mechanisms through which 
individuals and organizations dissatisfied with Medicare determinations 
affecting their rights in the Medicare program under the Social 
Security Act may obtain a hearing on these determinations. OMHA directs 
four field offices staff with Administrative Law Judges (ALJs) who 
conduct impartial ``de novo'' hearings and made decisions on appealed 
determinations involving Medicare appeals, as well as a Headquarters 
office.
    Section AK.10 Organization: The Office of Medicare Hearings and 
Appeals (OMHA) is under the direction of the Chief Administrative Law 
Judge, who reports directly to the Secretary, OMHA consists of the 
following components.
     Office of Medicare Hearings and Appeals, Immediate Office 
(AKA) Medicare Hearing and Appeals Field Offices (AKB1-4).
     Medicare Hearing and Appeals Field Offices (AKB1-4).
    --Medicare Hearings and Appeals Mid-Atlantic Field Office--Rosslyn, 
VA (AKB1)
    --Medicare Hearings and Appeals Mid-West Field Office--Cleveland, 
OH (AKB2)
    --Medicare Hearings and Appeals Western Field Office--Irvine, CA 
(AKB3)
    --Medicare Hearings and Appeals Southern Field Office--Miami, FL 
(AKB4)

Section AK.20 Functions

    A. The Office of Medicare Hearings and Appeals Immediate Office 
(AK): The Office of Medicare Hearings and Appeals Immediate Office 
(OMHA/IO) is headed by the Chief Administrative Law Judge (CALJ), who 
reports directly to the Secretary. The Chief Administrative Law Judge 
(CALJ) is responsible for carrying out OMHA's mission and implementing 
authorities granted to the ALJs by the Secretary. The CALJ is 
responsible for: (a) planning, directing, managing, coordinating, and 
maintaining the integrity of the field office hearings and appeals 
system by directing the planning, development, and coordination of 
regulations, policies and procedures governing the hearings and appeals 
program under the applicable statutes; (b) maintaining a hearings and 
appeal system which is impartial and which supports the tenets of 
fairness and equal treatment under the law; and (c) ensuring adherence 
to statutory procedures, time limits, and other procedural requirements 
of the Administrative Procedure Act, Medicare law and applicable HHS 
regulations. The CALJ provides executive leadership to, and 
administrative and management support functions for, the field offices 
which hold hearings and render decisions under the Social Security Act, 
and in that capacity establishes specific objectives, standards, and 
management and program policies with respect to the field office 
responsibilities.
    The Executive Director (ED) of OMHA/IO, reports to the CALJ, and is 
responsible for all operational matters and executive and managerial 
oversight in support of the mission of the office, with the exception 
of areas directly involving the conduct of adjudicatory hearings and 
the rendering of fair and impartial decisions ensuing from those 
hearings.
    B. Medicare Hearings and Appeals Field Offices (AB1-4). The Field 
Offices are headed by a Managing Administrative Law Judge (MALJ) who 
reports directly to the CALJ. The Managing Administrative Law Judge 
(MALJ) acts on behalf of the CALJ at the respective field office 
location on all matters involving the hearing process, and is directly 
responsible for the effective execution of the hearings process within 
the field location. The MALJ is responsible for: (a) Providing 
direction, leadership, management and guidance to the field office 
staff, including Administrative Law Judges and their staffs, and 
weighted workload attorneys; (b) field office implementation of 
policies, goals, objectives, and procedures pertaining to the hearings 
process, and formulating policies, goals, and objectives for the ALJs 
and support staff in their field office; (c) planning, organizing and 
administering field operations for scheduling and conducting 
independent and impartial hearings on appealed determinations involving 
adjudicatory hearings for authorities delegated to the ALJs by the 
Secretary; (d) developing and recommending OMHA action with respect to 
allegation of unfair hearings within the field operations; (e) upon 
request by ALJs providing advice and guidance in matters related to 
adjudicating cases under the provisions of the Social Security Act; and 
(f) conducting adjudicatory hearings under authorities delegated to the 
ALJs by the Secretary.
    The Hearing Office Manager (HOM), who reports to the Managing 
Administrative Law Judge (MALJ), is responsible for the day-to-day 
management and operations of the field office, with the exception of 
areas directly involving the conduct of adjudicatory hearings and the 
rending of fair and impartial decisions ensuing from those hearings. 
The Hearing Office Manager is responsible for: (a) Office management, 
including workload, personnel, and overall resource management; (b) 
executing and making critical evaluations and necessary revisions of 
applicable field office objectives, policies, practices, and 
procedures; (c) reviewing hearing practices and procedures to detect 
trends, training needs, and operational problems; (d) justifying the 
financial requirements needed to carry out the hearings in the field 
office; and (e) coordinating operation and administrative activities 
with OMHA/IO.
    Supervisory Administrative Law Judges within the Field Offices are 
responsible for conducting adjudicatory hearing for authorities granted 
to the ALJs by the Secretary. Supervisory Administrative Law Judges are 
also responsible for supervising staff attorney(s), paralegal(s), and 
hearing clerk(s).
    Attorneys and Paralegals are responsible for researching appeals; 
reviewing and evaluating case files; preparing briefs and transcripts; 
assisting in pre-hearing proceedings; drafting decisions; and, 
providing assistance to Administrative Law Judges.
    Hearing Clerks are responsible for assisting in the hearings and 
appeals process. Administrative support staff, under direction of the 
Hearing Office Manager, provide support services to hearings operations 
staff, and the ALJs.

    Dated: June 15, 2005.
Michael O. Leavitt,
Secretary.
[FR Doc. 05-12468 Filed 6-22-05; 8:45 am]
BILLING CODE 4140-04-M