Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2010, 48976-48977 [E9-22955]
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Federal Register / Vol. 74, No. 185 / Friday, September 25, 2009 / Notices
ensure that facilities with condition
level non-compliance on an initial
survey receive an onsite follow-up full
survey, in order to meet the
requirements at section 2005A2 of the
SOM;
• AOA developed and incorporated
measures to improve the accuracy and
consistency of data submissions to CMS
in order to meet the requirements at
§ 488.4(b);
• AOA revised its policies on
blackout dates to meet the requirements
at 2700A of the SOM;
• AOA revised its accreditation
decision letters to ensure that they are
accurate and contain all the required
elements for our Regional Office to
render a decision regarding the deemed
status of an accredited ASC;
• AOA revised and updated its
surveyor team handbook to include
references to its ASC deeming program;
• AOA extended its onsite survey
time allotted for review of the CfCs from
1 day to 2 days in order to meet the
requirements at § 488.26; and
• AOA removed all references to
mandatory consultative services from its
policies to avoid potential conflict of
interest issue.
To verify AOA’s continued
compliance with the provisions of this
final notice, we will conduct a followup corporate onsite visit within 1 year
of the date of publication of this notice.
B. Term of Approval
Based on the review and observations
described in section III of this final
notice, we have determined that the
AOA’s requirements for ASCs meet or
exceed our requirements. Therefore, we
approve AOA as a national accreditation
organization for ASCs that request
participation in the Medicare program,
effective October 23, 2009 through
October 23, 2013.
V. Collection of Information
Requirements
jlentini on DSKJ8SOYB1PROD with NOTICES
This document does not impose
information collection and
recordkeeping requirements.
Consequently, it need not be reviewed
by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 35).
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance; and Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program)
VerDate Nov<24>2008
18:52 Sep 24, 2009
Jkt 217001
Dated: September 10, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare
& Medicaid Services.
[FR Doc. E9–22956 Filed 9–24–09; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–4141–N]
A. Medicare Part A and Part B Appeals
Medicare Program; Medicare Appeals;
Adjustment to the Amount in
Controversy Threshold Amounts for
Calendar Year 2010
AGENCY: Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
SUMMARY: This notice announces the
annual adjustment in the amount in
controversy (AIC) threshold amounts for
Administrative Law Judge (ALJ)
hearings and judicial review under the
Medicare appeals process. The
adjustment to the AIC threshold
amounts will be effective for requests
for ALJ hearings and judicial review
filed on or after January 1, 2010. The
2010 AIC threshold amounts are $130
for ALJ hearings and $1,260 for judicial
review.
DATES: Effective Date: This notice is
effective on January 1, 2010.
FOR FURTHER INFORMATION CONTACT: Liz
Hosna, (410) 786–4993.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1869(b)(1)(E) of the Social
Security Act (the Act), as amended by
section 521 of the Medicare, Medicaid,
and SCHIP Benefits Improvement and
Protection Act of 2000 (BIPA),
established AIC threshold amounts for
ALJ hearing requests and judicial review
at $100 and $1000, respectively, for
Medicare Part A and Part B appeals.
Section 940 of the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003, amended
section 1869(b)(1)(E) of the Act to
require the AIC threshold amounts for
ALJ hearings and judicial review to be
adjusted annually. The AIC threshold
amounts are to be adjusted, as of
January 2005, by the percentage increase
in the medical care component of the
consumer price index for all urban
consumers (U.S. city average) for July
2003 to July of the year preceding the
year involved and rounded to the
nearest multiple of $10. Section
PO 00000
Frm 00076
Fmt 4703
940(b)(2) of the MMA provided
conforming amendments to apply the
AIC adjustment requirement to
Medicare Part C (Medicare Advantage
‘‘MA’’) appeals and certain health
maintenance organization and
competitive health plan appeals. Health
care prepayment plans are also subject
to MA appeals rules, including the AIC
adjustment requirement. Section 101 of
the MMA provides for the application of
the AIC adjustment requirement to
Medicare Part D appeals.
Sfmt 4703
The statutory formula for the annual
adjustment to the AIC threshold
amounts for ALJ hearings and judicial
review of Medicare Part A and Part B
appeals, set forth at section
1869(b)(1)(E) of the Act, is included in
the applicable implementing
regulations, 42 CFR part 405, subpart I,
at § 405.1006(b). The regulations require
the Secretary of the Department of
Health and Human Services (the
Secretary) to publish changes to the AIC
threshold amounts in the Federal
Register (§ 405.1006(b)(2)). In order to
be entitled to a hearing before an ALJ,
a party to a proceeding must meet the
AIC requirements at § 405.1006(b).
Similarly, a party must meet the AIC
requirements at § 405.1006(c) at the time
judicial review is requested for the court
to have jurisdiction over the appeal
(§ 405.1136(a)).
B. Medicare Part C (Medicare
Advantage) Appeals
Section 940(b)(2) of the MMA applies
the AIC adjustment requirement to Part
C (MA) appeals by amending section
1852(g)(5) of the Act. The implementing
regulations for Medicare Part C appeals
are found at 42 CFR part 422, subpart
M. Specifically, § 422.600 and § 422.612
discuss the AIC threshold amounts for
ALJ hearings and judicial review.
Section 422.600 grants any party to
the reconsideration, except the MA
organization, who is dissatisfied with
the reconsideration determination, a
right to an ALJ hearing as long as the
amount remaining in controversy after
reconsideration meets the threshold
requirement established annually by the
Secretary. Section 422.612 states that
any party, including the MA
organization, may request judicial
review if, in part, the amount in
controversy meets the threshold
requirement established annually by the
Secretary.
E:\FR\FM\25SEN1.SGM
25SEN1
48977
Federal Register / Vol. 74, No. 185 / Friday, September 25, 2009 / Notices
C. Health Maintenance Organizations,
Competitive Medical Plans, and Health
Care Prepayment Plans
Section 1876(c)(5)(B) of the Act states
that the annual adjustment to the
amount in controversy dollar amounts
set forth in section 1869(b)(1)(E) of the
Act applies to certain beneficiary
appeals within the context of health
maintenance organizations and
competitive medical plans. The
applicable implementing regulations for
Medicare Part C appeals are set forth in
42 CFR part 422, subpart M, and as
discussed above, apply to these appeals.
The Medicare Part C appeals rules also
apply to health care prepayment plan
appeals.
D. Medicare Part D (Prescription Drug
Plan) Appeals
The annually adjusted AIC threshold
amounts for ALJ hearings and judicial
review that apply to Medicare Parts A,
B, and C appeals also apply to Medicare
Part D appeals. Section 101 of the MMA
added section 1860D–4(h)(1) of the Act
regarding Part D appeals. This statutory
provision requires a prescription drug
plan sponsor to meet the requirements
set forth in sections 1852(g)(4) and (g)(5)
of the Act, in a similar manner as MA
organizations. As noted above, the
annually adjusted AIC threshold
requirement was added to section
1852(g)(5) of the Act by section
940(b)(2)(A) of the MMA. The
implementing regulations for Medicare
Part D appeals can be found at 42 CFR
part 423, subpart M. The regulations
impart at § 423.562(c) that, unless the
Part D appeals rules provide otherwise,
the Part C appeals rules (including the
annually adjusted AIC threshold
amount) apply to Part D appeals to the
extent they are appropriate. More
specifically, § 423.610 and § 423.630 of
the Part D appeals rules discuss the AIC
threshold amounts for ALJ hearings and
judicial review. Section 423.610(a)
grants a Part D enrollee, who is
dissatisfied with the Independent
Review Entity (IRE) reconsideration
determination, a right to an ALJ hearing
if the amount remaining in controversy
after the IRE reconsideration meets the
threshold amount established annually
by the Secretary. Section 423.630(a)
allows a Part D enrollee to request
judicial review of an ALJ’s decision if,
in part, the AIC meets the threshold
amount established annually by the
Secretary.
II. Annual AIC Adjustments
A. AIC Adjustment Formula and AIC
Adjustments
As previously noted, section 940 of
the MMA requires that the AIC
threshold amounts be adjusted
annually, beginning in January of 2005,
by the percentage increase in the
medical care component of the
consumer price index (CPI) for all urban
consumers (U.S. city average) for July
2003 to the July of the preceding year
involved and rounded to the nearest
multiple of $10.
B. Calendar Year 2010
The AIC threshold amount for ALJ
hearing requests will rise to $130 and
the AIC threshold amount for judicial
review will rise to $1,260 for the 2010
calendar year. These new amounts are
based on the 26.3 percent increase in
the medical care component of the CPI
from July of 2003 to July of 2009. The
CPI level was at 297.6 in July of 2003
and rose to 375.739 in July of 2009. This
change accounted for the 26.3 percent
increase. The AIC threshold amount for
ALJ hearing requests changes to $126.26
based on the 26.3 percent increase. In
accordance with section 940 of the
MMA, this amount is rounded to the
nearest multiple of $10. Therefore, the
2010 AIC threshold amount for ALJ
hearings is $130. The AIC threshold
amount for judicial review changes to
$1,262.56 based on the 26.3 percent
increase. This amount was rounded to
the nearest multiple of $10, resulting in
a 2010 AIC threshold amount of $1,260.
C. Summary Table of Adjustments in
the AIC Threshold Amounts
In Table 1 below, we list the (CY)
2005 through 2010 threshold amounts.
TABLE 1—AMOUNT-IN-CONTROVERSY THRESHOLD AMOUNTS
CY 2005
ALJ Hearing .............................................
Judicial Review ........................................
CY 2006
$100
$1050
CY 2007
$110
$1090
CY 2008
$110
$1130
CY 2009
$120
$1180
$120
$1,220
CY 2010
$130
$1,260
*CY—Calendar Year.
III. Collection of Information
Requirements (If Applicable)
jlentini on DSKJ8SOYB1PROD with NOTICES
This document does not impose
information collection and
recordkeeping requirements.
Consequently, it need not be reviewed
by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 35).
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program; No. 93.773 Medicare—Hospital
Insurance Program; and No. 93.774,
Medicare—Supplementary Medical
Insurance Program)
Dated: September 1, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare
& Medicaid Services.
[FR Doc. E9–22955 Filed 9–24–09; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–3215–N]
Medicare Program; Meeting of the
Medicare Evidence Development and
Coverage Advisory Committee—
November 18, 2009
AGENCY: Centers for Medicare &
Medicaid Services (CMS), HHS.
VerDate Nov<24>2008
18:52 Sep 24, 2009
Jkt 217001
PO 00000
Frm 00077
Fmt 4703
Sfmt 4703
ACTION:
Notice of meeting.
SUMMARY: This notice announces that a
public meeting of the Medicare
Evidence Development & Coverage
Advisory Committee (MEDCAC)
(‘‘Committee’’) will be held on
Wednesday, November 18, 2009. The
Committee generally provides advice
and recommendations concerning the
adequacy of scientific evidence needed
to determine whether certain medical
items and services can be covered under
the Medicare statute. This meeting will
focus on the quality of evidence
surrounding the diagnosis and treatment
of secondary lymphedema. This meeting
is open to the public in accordance with
the Federal Advisory Committee Act (5
U.S.C. App. 2, section 10(a)).
DATES: Meeting date: The public
meeting will be held on Wednesday,
E:\FR\FM\25SEN1.SGM
25SEN1
]]>Agencies
[Federal Register Volume 74, Number 185 (Friday, September 25, 2009)]
[Notices]
[Pages 48976-48977]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-22955]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-4141-N]
Medicare Program; Medicare Appeals; Adjustment to the Amount in
Controversy Threshold Amounts for Calendar Year 2010
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces the annual adjustment in the amount in
controversy (AIC) threshold amounts for Administrative Law Judge (ALJ)
hearings and judicial review under the Medicare appeals process. The
adjustment to the AIC threshold amounts will be effective for requests
for ALJ hearings and judicial review filed on or after January 1, 2010.
The 2010 AIC threshold amounts are $130 for ALJ hearings and $1,260 for
judicial review.
DATES: Effective Date: This notice is effective on January 1, 2010.
FOR FURTHER INFORMATION CONTACT: Liz Hosna, (410) 786-4993.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1869(b)(1)(E) of the Social Security Act (the Act), as
amended by section 521 of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (BIPA), established AIC
threshold amounts for ALJ hearing requests and judicial review at $100
and $1000, respectively, for Medicare Part A and Part B appeals.
Section 940 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, amended section 1869(b)(1)(E) of the Act to
require the AIC threshold amounts for ALJ hearings and judicial review
to be adjusted annually. The AIC threshold amounts are to be adjusted,
as of January 2005, by the percentage increase in the medical care
component of the consumer price index for all urban consumers (U.S.
city average) for July 2003 to July of the year preceding the year
involved and rounded to the nearest multiple of $10. Section 940(b)(2)
of the MMA provided conforming amendments to apply the AIC adjustment
requirement to Medicare Part C (Medicare Advantage ``MA'') appeals and
certain health maintenance organization and competitive health plan
appeals. Health care prepayment plans are also subject to MA appeals
rules, including the AIC adjustment requirement. Section 101 of the MMA
provides for the application of the AIC adjustment requirement to
Medicare Part D appeals.
A. Medicare Part A and Part B Appeals
The statutory formula for the annual adjustment to the AIC
threshold amounts for ALJ hearings and judicial review of Medicare Part
A and Part B appeals, set forth at section 1869(b)(1)(E) of the Act, is
included in the applicable implementing regulations, 42 CFR part 405,
subpart I, at Sec. 405.1006(b). The regulations require the Secretary
of the Department of Health and Human Services (the Secretary) to
publish changes to the AIC threshold amounts in the Federal Register
(Sec. 405.1006(b)(2)). In order to be entitled to a hearing before an
ALJ, a party to a proceeding must meet the AIC requirements at Sec.
405.1006(b). Similarly, a party must meet the AIC requirements at Sec.
405.1006(c) at the time judicial review is requested for the court to
have jurisdiction over the appeal (Sec. 405.1136(a)).
B. Medicare Part C (Medicare Advantage) Appeals
Section 940(b)(2) of the MMA applies the AIC adjustment requirement
to Part C (MA) appeals by amending section 1852(g)(5) of the Act. The
implementing regulations for Medicare Part C appeals are found at 42
CFR part 422, subpart M. Specifically, Sec. 422.600 and Sec. 422.612
discuss the AIC threshold amounts for ALJ hearings and judicial review.
Section 422.600 grants any party to the reconsideration, except the
MA organization, who is dissatisfied with the reconsideration
determination, a right to an ALJ hearing as long as the amount
remaining in controversy after reconsideration meets the threshold
requirement established annually by the Secretary. Section 422.612
states that any party, including the MA organization, may request
judicial review if, in part, the amount in controversy meets the
threshold requirement established annually by the Secretary.
[[Page 48977]]
C. Health Maintenance Organizations, Competitive Medical Plans, and
Health Care Prepayment Plans
Section 1876(c)(5)(B) of the Act states that the annual adjustment
to the amount in controversy dollar amounts set forth in section
1869(b)(1)(E) of the Act applies to certain beneficiary appeals within
the context of health maintenance organizations and competitive medical
plans. The applicable implementing regulations for Medicare Part C
appeals are set forth in 42 CFR part 422, subpart M, and as discussed
above, apply to these appeals. The Medicare Part C appeals rules also
apply to health care prepayment plan appeals.
D. Medicare Part D (Prescription Drug Plan) Appeals
The annually adjusted AIC threshold amounts for ALJ hearings and
judicial review that apply to Medicare Parts A, B, and C appeals also
apply to Medicare Part D appeals. Section 101 of the MMA added section
1860D-4(h)(1) of the Act regarding Part D appeals. This statutory
provision requires a prescription drug plan sponsor to meet the
requirements set forth in sections 1852(g)(4) and (g)(5) of the Act, in
a similar manner as MA organizations. As noted above, the annually
adjusted AIC threshold requirement was added to section 1852(g)(5) of
the Act by section 940(b)(2)(A) of the MMA. The implementing
regulations for Medicare Part D appeals can be found at 42 CFR part
423, subpart M. The regulations impart at Sec. 423.562(c) that, unless
the Part D appeals rules provide otherwise, the Part C appeals rules
(including the annually adjusted AIC threshold amount) apply to Part D
appeals to the extent they are appropriate. More specifically, Sec.
423.610 and Sec. 423.630 of the Part D appeals rules discuss the AIC
threshold amounts for ALJ hearings and judicial review. Section
423.610(a) grants a Part D enrollee, who is dissatisfied with the
Independent Review Entity (IRE) reconsideration determination, a right
to an ALJ hearing if the amount remaining in controversy after the IRE
reconsideration meets the threshold amount established annually by the
Secretary. Section 423.630(a) allows a Part D enrollee to request
judicial review of an ALJ's decision if, in part, the AIC meets the
threshold amount established annually by the Secretary.
II. Annual AIC Adjustments
A. AIC Adjustment Formula and AIC Adjustments
As previously noted, section 940 of the MMA requires that the AIC
threshold amounts be adjusted annually, beginning in January of 2005,
by the percentage increase in the medical care component of the
consumer price index (CPI) for all urban consumers (U.S. city average)
for July 2003 to the July of the preceding year involved and rounded to
the nearest multiple of $10.
B. Calendar Year 2010
The AIC threshold amount for ALJ hearing requests will rise to $130
and the AIC threshold amount for judicial review will rise to $1,260
for the 2010 calendar year. These new amounts are based on the 26.3
percent increase in the medical care component of the CPI from July of
2003 to July of 2009. The CPI level was at 297.6 in July of 2003 and
rose to 375.739 in July of 2009. This change accounted for the 26.3
percent increase. The AIC threshold amount for ALJ hearing requests
changes to $126.26 based on the 26.3 percent increase. In accordance
with section 940 of the MMA, this amount is rounded to the nearest
multiple of $10. Therefore, the 2010 AIC threshold amount for ALJ
hearings is $130. The AIC threshold amount for judicial review changes
to $1,262.56 based on the 26.3 percent increase. This amount was
rounded to the nearest multiple of $10, resulting in a 2010 AIC
threshold amount of $1,260.
C. Summary Table of Adjustments in the AIC Threshold Amounts
In Table 1 below, we list the (CY) 2005 through 2010 threshold
amounts.
Table 1--Amount-in-Controversy Threshold Amounts
--------------------------------------------------------------------------------------------------------------------------------------------------------
CY 2005 CY 2006 CY 2007 CY 2008 CY 2009 CY 2010
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALJ Hearing............................................. $100 $110 $110 $120 $120 $130
Judicial Review......................................... $1050 $1090 $1130 $1180 $1,220 $1,260
--------------------------------------------------------------------------------------------------------------------------------------------------------
*CY--Calendar Year.
III. Collection of Information Requirements (If Applicable)
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995 (44 U.S.C. 35).
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program;
and No. 93.774, Medicare--Supplementary Medical Insurance Program)
Dated: September 1, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E9-22955 Filed 9-24-09; 8:45 am]
BILLING CODE 4120-01-P
