Medicare Program; Appellant Forum Regarding the Administrative Law Judge Hearing Program for Medicare Claim Appeals, 393-395 [2013-31461]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 79, Number 2 (Friday, January 3, 2014)]
[Notices]
[Pages 393-395]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-31461]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Medicare Program; Appellant Forum Regarding the Administrative 
Law Judge Hearing Program for Medicare Claim Appeals

AGENCY: Office of Medicare Hearings and Appeals (OMHA), HHS.

ACTION: Notice of Meeting.

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SUMMARY: This notice announces an Office of Medicare Hearings and 
Appeals (OMHA) Medicare Appellant Forum. The purpose of this event is 
to provide updates to OMHA appellants on the status of OMHA operations; 
to relay information on a number of OMHA initiatives designed to 
mitigate a growing backlog in the processing of Medicare appeals at the 
OMHA-level of the administrative appeals process; and provide 
information on measures that appellants can take to make the 
administrative appeals process work more efficiently at the OMHA-level.

DATES: Meeting Date: The OMHA Medicare Appellant Forum announced in 
this notice will be held on Wednesday, February 12, 2014. The OMHA 
Medicare Appellant Forum will begin at 10:00 a.m. Eastern Standard Time 
(e.s.t.) and check-in will begin at 9:00 a.m. e.s.t.
    Deadline for Registration of Attendees and Requests for Special 
Accommodation: The deadline to register to attend the OMHA Medicare 
Appellants Forum and request a special accommodation, as provided for 
in the American's with Disabilities Act, is 5:00

[[Page 394]]

p.m., e.s.t. on Tuesday, January 28, 2014.

ADDRESSES: Meeting Location: The OMHA Medicare Appellants Forum will be 
held in the Cohen Auditorium of the Wilbur J. Cohen building located at 
330 Independence Ave. SW., Washington, DC 20024.
    We are exploring the feasibility of providing a toll-free phone 
line and/or live stream technology and/or webinar. Information on these 
options will be posted at a later date on the OMHA Web site; https://www.hhs.gov/omha/.
    Registration and Special Accommodations: Individuals wishing to 
attend the OMHA Medicare Appellant Forum must register by following the 
on-line registration instructions located in section III. of this 
notice or by contacting staff listed in the FOR FURTHER INFORMATION 
CONTACT section of this notice. Individuals who need special 
accommodations should contact staff listed in the FOR FURTHER 
INFORMATION CONTACT section of this notice.

FOR FURTHER INFORMATION CONTACT: Sylvia Baquero, (703) 235-0145, 
sylvia.baquero@hhs.gov, or Paula Taylor, (703) 235-0125, 
paula.taylor@hhs.gov. Alternatively, you may forward your requests via 
email to OSOMHAAppellantForum@hhs.gov; please indicate ``Request for 
information'' or ``Request for special accommodation'' in the subject 
line.

SUPPLEMENTARY INFORMATION:

I. Background

    The Office of Medicare Hearings and Appeals (OMHA), a staff 
division within the Office of the Secretary of the U.S. Department of 
Health and Human Services (HHS), administers the nationwide 
Administrative Law Judge hearing program for Medicare claim and 
entitlement appeals under sections 1869(b)(1), 1155, 1876, 1852(g)(5), 
and 1860D-4(h) of the Social Security Act. OMHA ensures that Medicare 
beneficiaries and the providers and suppliers that furnish items or 
services to Medicare beneficiaries have a fair and impartial forum to 
address disagreements with Medicare coverage determinations made by 
Medicare contractors and determinations related to Medicare eligibility 
and entitlement, and income-related premium surcharges made by the 
Social Security Administration.
    OMHA serves a broad sector of the public, including Medicare 
providers and suppliers, and Medicare beneficiaries, who are often 
elderly or disabled and among the nation's most vulnerable populations. 
OMHA administers its program in four field offices, including the 
Southern Field Office in Miami, Florida; the Midwestern Field Office in 
Cleveland, Ohio; the Western Field Office in Irvine, California; and 
the Mid-Atlantic Field Office in Arlington, Virginia. OMHA uses in-
person, video-teleconferencing (VTC) and telephone conference formats 
to provide appellants with hearings.
    OMHA was established in July 2005 pursuant to section 931 of the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
(Pub. L. 108-173), which required the transfer of responsibility for 
the Administrative Law Judge hearing level of the Medicare claim and 
entitlement appeals process from the Social Security Administration to 
HHS. OMHA was expected to improve service to appellants and reduce the 
average 368-day time frame to receive a hearing decision that 
appellants experienced with the Social Security Administration, in 
accordance with 90-day adjudication time frame mandate required by the 
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act 
of 2000 (Pub. L. 106-554).
    At the time of OMHA was established, it was envisioned that OMHA 
would receive the traditional claim and entitlement appeals workload 
from the Medicare Part A and Part B programs, and the Medicare Part C 
Medicare Advantage program; and a new workload of appeals from the 
Medicare Part D Prescription Drug program and the Income Related 
Monthly Adjustment Amount (IRMAA) premium surcharges assessed by the 
Social Security Administration. However, beginning in fiscal year 2010, 
new workloads including permanent establishment of the Recovery Audit 
(RA) program and termination of several demonstration projects 
involving Medicare State Agencies (MSA), have emerged that had not been 
built into the OMHA workload models. The steady growth in traditional 
Medicare appeals combined with these new workloads has strained OMHA's 
ability to meet the adjudication time frame mandate while maintaining 
quality.
    As a result of the anticipated workload increase from the 
traditional appeals and the increased workload resulting from MSA 
appeals and the RA program, a backlog of appeals began to form in 
fiscal year 2012 in which more requests for hearing were being filed 
than could be adjudicated. In 2013, appealed claims related to the RA 
program grew to over 136,000, further exacerbating the backlog of cases 
and resulting in a substantial increase in the adjudication time frame.
    As the unprecedented growth in claim appeals continues to exceed 
the available adjudication resources to address appeals, OMHA is taking 
measures to mitigate the workload increase and planning future 
activities to bring efficiencies to the appeals process at the OMHA-
level. One of the immediate measures has been to ensure that the 
relatively small numbers of beneficiary-initiated appeals are being 
immediately addressed by prioritizing their cases. For the remaining 
cases, OMHA has suspended assignments of new requests for hearing until 
an adjudicator becomes available, which will allow cases to be assigned 
more efficiently on a first in/first out basis as an Administrative Law 
Judge's case docket is able to accommodate additional workload. In 
addition, OMHA is vigorously pursuing an electronic case adjudication 
processing environment (ECAPE) to bring new efficiencies and appellant-
access to the OMHA-level of the appeals process.
    The OMHA Medicare Appellant Forum will address these initiatives, 
as well as potential future initiatives, and will solicit input from 
the appellant community to help OMHA evaluate its policies and 
procedures to achieve meaningful backlog reduction strategies and 
process efficiencies while remaining compliant with applicable legal 
authorities.

II. Medicare Claim Appeal Appellant Forum and Conference Calling/
Webinar Information

A. Format of the OMHA Medicare Appellant Forum

    As noted in section I. of this notice, OMHA is conducting this 
outreach to appellants of the Medicare claim appeals process to provide 
updates on initiatives to mitigate a growing backlog in the processing 
Medicare appeals at the OMHA-level, and to solicit input to achieve 
meaningful backlog reduction strategies and process efficiencies. 
Information regarding the OMHA Medicare Appellant Forum can be found on 
the OMHA Web site at: https://www.hhs.gov/omha/.
    The majority of the forum will be reserved for presentations of 
workload data, processes and policy discussions, and recommendations 
from agency presenters. The time for each presentation will be 
approximately 30 to 60 minutes and will be based on the material being 
addressed in the presentation.
    Questions and comments from in-person attendees will be solicited 
at the

[[Page 395]]

end of each planned presentation and during a separate question and 
answer session as time permits. In addition, questions related to the 
OMHA-level of the Medicare claim appeals process will also be accepted 
on the attendee registration, for potential response during the 
appropriate presentation.

B. Conference Call, Live Streaming, and Webinar Information

    For participants who cannot attend the OMHA Medicare Appellant 
Forum in person, there may be an option to view and participate in the 
OMHA Medicare Appellant Forum via live streaming technology and/or a 
webinar. Information on the whether these capabilities will be 
available as part of this forum will be posted on the OMHA Web site at: 
https://www.hhs.gov/omha/. Please continue to check the Web 
site for updates on this upcoming event.
    Disclaimer: We cannot guarantee reliability for live streaming 
technology and/or a webinar.

III. Registration Instructions

    The OMHA Executive Office is coordinating attendee registration for 
the OMHA Medicare Appellant Forum. While there is no registration fee, 
individuals planning to attend the forum must register to attend. In-
person participation is limited to two (2) representatives from each 
organization. Additional individuals can participate by telephone 
conference or webinar if these services are made available. Information 
on participation by telephone conference or webinar will be posted on 
the OMHA Web site at: https://www.hhs.gov/omha/. Registration 
may be completed online at the following web address: https://www.hhs.gov/omha/. Seating capacity for in-person attendees 
is limited to the first 400 registrants.
    After completing the registration, online registrants will receive 
a confirmation email which they should bring with them to the 
meeting(s). If you are unable to register online, you may register by 
sending an email to OSOMHAAppellantForum@hhs.gov. Please include your 
first and last name, title, organization, address, office telephone 
number, and email address. If seating capacity has been reached, you 
will be notified that the meeting has reached capacity.

IV. Security, Building, and Parking Guidelines

    Because the OMHA Medicare Appellant Forum will be conducted on 
Federal property, for security reasons, any persons wishing to attend 
these meetings must register by the date specified in the DATES section 
of this notice. Please allow sufficient time to go through the security 
checkpoints. It is suggested that you arrive at the Wilbur J. Cohen 
building, located at 330 Independence Ave. SW., Washington, DC 20024, 
no later than 9:30 a.m. e.s.t. if you are attending the forum in person 
so that you will be able to arrive promptly for the meeting.
    Security measures include the following:
     Presentation of photographic identification to the Federal 
Protective Service or Guard Service personnel.
     Passing through a metal detector and inspection of items 
brought into the building. We note that all items brought to the Cohen 
Building, whether personal or for the purpose of demonstration or to 
support a demonstration, are subject to inspection. We cannot assume 
responsibility for coordinating the receipt, transfer, transport, 
storage, set-up, safety, or timely arrival of any personal belongings 
or items used for demonstration or to support a demonstration.

    Note: Individuals who are not registered in advance will not be 
permitted to enter the building and will be unable to attend the 
forum in person. The public may not enter the building earlier than 
45 minutes prior to the convening of the forum.

    Attendees must enter the Cohen Building thru the C-Street entrance 
and proceed to the registration desk. All visitors must be escorted in 
areas other than the auditorium area and access to the rest rooms on 
the same level in the building. Seating capacity is limited to the 
first 400 registrants.
    Parking in Federal buildings is not available for this event. In 
addition, street side and commercial parking is extremely limited in 
the downtown area. Attendees are advised to use Metro-rail to either 
the Federal Center SW station (Blue/Orange line) or the L'Enfant Plaza 
station (Yellow/Green or Blue/Orange lines). The Wilbur J. Cohen 
building is approximately 1\1/2\ blocks from each of these Metro-rail 
stops.

(Catalog of Federal Domestic Assistance Program No. 93.770, 
Medicare--Prescription Drug Coverage; Program No. 93.773, Medicare--
Hospital Insurance; and Program No. 93.774, Medicare--Supplementary 
Medical Insurance Program)

    Dated: December 24, 2013.
Nancy J. Griswold,
Chief Administrative Law Judge, Office of Medicare Hearings and 
Appeals.
[FR Doc. 2013-31461 Filed 1-2-14; 8:45 am]
BILLING CODE 4150-46-P