Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim and Entitlement Appeals; Quarterly Listing of Program Issuances-October Through December 2015, 8969-8970 [2016-03634]

Download as PDF Federal Register / Vol. 81, No. 35 / Tuesday, February 23, 2016 / Notices FDA will do its best to accommodate requests to present. FDA urges individuals and organizations with common interests to consolidate or coordinate their comments, and request a single time for a joint presentation. For those requesters with Internet access, Caryn Cohen (see FOR FURTHER INFORMATION CONTACT) will email you regarding your request to speak by March 1, 2016. IV. Transcripts Please be advised that as soon as a transcript is available, it will be accessible at https:// www.regulations.gov. It may be viewed at the Division of Dockets Management (HFA–305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852. A transcript will also be available in either hardcopy or on CD–ROM, after submission of a Freedom of Information request. The Freedom of Information office address is available on the Agency’s Web site at https://www.fda.gov. It will also be available after the workshop at https:// www.fda.gov/TobaccoProducts/ NewsEvents/ucm238308.htm as soon as the official transcript is finalized. Dated: February 18, 2016. Leslie Kux, Associate Commissioner for Policy. [FR Doc. 2016–03712 Filed 2–22–16; 8:45 am] BILLING CODE 4164–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES [OMHA–1503–N] Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim and Entitlement Appeals; Quarterly Listing of Program Issuances—October Through December 2015 Office of Medicare Hearings and Appeals (OMHA), HHS. ACTION: Notice. AGENCY: This quarterly notice lists of the OMHA Case Processing Manual (OCPM) manual instructions that were published from October through December, 2015. This manual standardizes the day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statutes, regulations and OMHA directives, and gives OMHA staff direction for processing appeals at the OMHA level of adjudication. FOR FURTHER INFORMATION CONTACT: Amanda Axeen, by telephone at (571) mstockstill on DSK4VPTVN1PROD with NOTICES SUMMARY: VerDate Sep<11>2014 17:06 Feb 22, 2016 Jkt 238001 777–2705, or by email at amanda.axeen@hhs.gov. 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, organization and coverage determination, and entitlement appeals under sections 1869, 1155, 1876(c)(5)(B), 1852(g)(5), and 1860D– 4(h) of the Social Security Act (the Act). OMHA ensures that Medicare beneficiaries and the providers and suppliers that furnish items or services to Medicare beneficiaries, as well as Medicare Advantage Organizations (MAOs) and Medicaid State Agencies, have a fair and impartial forum to address disagreements with Medicare coverage and payment determinations made by Medicare contractors, MAOs, or Part D Plan Sponsors (PDPSs), and determinations related to Medicare eligibility and entitlement, Part B late enrollment penalty, and income-related monthly adjustment amounts (IRMAA) made by the Social Security Administration (SSA). The Medicare claim, organization and coverage determination appeals processes consist of four levels of administrative review, and a fifth level of review with the Federal district courts after administrative remedies under HHS regulations have been exhausted. The first two levels of review are administered by the Centers for Medicare & Medicaid Services (CMS) and conducted by Medicare contractors for claim appeals, by MAOs and an independent review entity for Part C organization determination appeals, or by PDPSs and an independent review entity for Part D coverage determination appeals. The third level of review is administered by OMHA and conducted by Administrative Law Judges. The fourth level of review is administered by the HHS Departmental Appeals Board (DAB) and conducted by the Medicare Appeals Council. In addition, OMHA and the DAB administer the second and third levels of appeal, respectively, for Medicare eligibility, entitlement, Part B late enrollment penalty, and IRMAA reconsiderations made by SSA; a fourth level of review with the Federal district courts is available after administrative remedies within SSA and HHS have been exhausted. Sections 1869, 1155, 1876(c)(5)(B), 1852(g)(5), and 1860D–4(h) of the Act are implemented through the PO 00000 Frm 00075 Fmt 4703 Sfmt 4703 8969 regulations at 42 CFR part 405 subparts I and J; part 417, subpart Q; part 422, subpart M; part 423, subparts M and U; and part 478, subpart B. As noted above, OMHA administers the nationwide Administrative Law Judge hearing program in accordance with these statutes and applicable regulations. As part of that effort, OMHA is establishing a manual, the OMHA Case Processing Manual (OCPM). Through the OCPM, the OMHA Chief Administrative Law Judge establishes the day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statutes, regulations and OMHA directives. The OCPM provides direction for processing appeals at the OMHA level of adjudication for Medicare Part A and B claims; Part C organization determinations; Part D coverage determinations; and SSA eligibility and entitlement, Part B late enrollment penalty, and IRMAA determinations. Section 1871(c) of the Act requires that we publish a list of all Medicare manual instructions, interpretive rules, statements of policy, and guidelines of general applicability not issued as regulations at least every 3 months in the Federal Register. II. Format for the Quarterly Issuance Notices This quarterly notice provides the specific updates to the OCPM that have occurred in the 3-month period. A hyperlink to the available chapters on the OMHA Web site is provided below. The OMHA Web site contains the most current, up-to-date chapters and revisions to chapters, and will be available earlier than we publish our quarterly notice. We believe the OMHA Web site list provides more timely access to the current OCPM chapters for those involved in the Medicare claim, organization and coverage determination and entitlement appeals processes. We also believe the Web site offers the public a more convenient tool for real time access to current OCPM provisions. In addition, OMHA has a listserv to which the public can subscribe to receive immediate notification of any updates to the OMHA Web site. This listserv avoids the need to check the OMHA Web site, as update notifications are sent to subscribers as they occur. If accessing the OMHA Web site proves to be difficult, the contact person listed above can provide the information. III. How To Use the Notice This notice lists the OCPM chapters and subjects published during the quarter covered by the notice so the E:\FR\FM\23FEN1.SGM 23FEN1 8970 Federal Register / Vol. 81, No. 35 / Tuesday, February 23, 2016 / Notices reader may determine whether any are of particular interest. We expect this notice to be used in concert with the previously published notices. The OCPM can be accessed at https:// www.hhs.gov/omha/OMHA_Case_ Processing_Manual/. mstockstill on DSK4VPTVN1PROD with NOTICES IV. OCPM Releases for October Through December 2015 The OCPM is used by OMHA adjudicators and staff to administer the OMHA program. It offers day-to-day operating instructions, policies, and procedures based on statutes and regulations, and OMHA directives. The following is a list and description of new OCPM provisions and the subject matter that have been implemented in the covered 3-month period. The full text of current OCPM provisions is available on our Web site at https://www.hhs.gov/omha/OMHA_ Case_Processing_Manual/. structure for documents and evidence received in support of Medicare Part C requests for hearing filed with OMHA. This chapter standardizes the way that OMHA prepares these files for further processing. Chapter 7, Scheduling and Notices of Hearing. This new chapter describes the scheduling and notice of hearing process in Medicare C cases and provides guidance on sending amended notices of hearing, rescheduling or cancelling hearings and issuing notices for supplemental hearings. Chapter 13, Closing the Case. This new chapter describes the necessary administrative steps to finalize and close a Medicare Part C case. The chapter also provides guidance on mailing the notice of disposition and shipping the case file. OCPM Division IV: Part D Coverage Determinations Chapter 4, Administrative Record. OCPM Division I: General Matters This new chapter describes the Chapter 7, Adjudication Time Frames. minimum organization and exhibiting This new chapter describes the cases structure for documents and evidence subject to statutory time frames, tolling received in support of Medicare Part D and waivers of adjudication time requests for hearing filed with OMHA. frames, and provides instruction on how This chapter standardizes the way that to handle cases escalated from the OMHA prepares these files for further Qualified Independent Contractor (QIC) processing. Chapter 7, Scheduling and Notices of to OMHA and from OMHA to the Hearing. This new chapter describes the Medicare Appeals Council. scheduling and notice of hearing OCPM Division II: Part A/B Claim process in Medicare D cases and Determinations provides guidance on sending amended Chapter 4, Administrative Record. notices of hearing, rescheduling or This new chapter describes the cancelling hearings and issuing notices minimum organization and exhibiting for supplemental hearings. structure for documents and evidence Chapter 13, Closing the Case. This received in support of Medicare Part A new chapter describes the necessary and B requests for hearing filed with administrative steps to finalize and OMHA. This chapter standardizes the close a Medicare Part D case. The way that OMHA prepares these files for chapter also provides guidance on further processing. mailing the notice of disposition and Chapter 7, Scheduling and Notices of shipping the case file. Hearing. This new chapter describes the OCPM Division V: SSA Determinations scheduling and notice of hearing Chapter 4, Administrative Record. process in Medicare Part A and Part B cases and provides guidance on sending This new chapter describes the minimum organization and exhibiting amended notices of hearing, rescheduling or cancelling hearings and structure for documents and evidence received in support of requests for issuing notices for supplemental hearing filed with OMHA following hearings. reconsiderations of Medicare eligibility Chapter 13, Closing the Case. This and entitlement, Part B late enrollment new chapter describes the necessary penalties, and Part B and Part D administrative steps to finalize and IRMAAs issued by SSA. This chapter close a Medicare Part A or Part B case. standardizes the way that OMHA The chapter also provides guidance on prepares these files for further mailing the notice of disposition and processing. shipping the case file. Chapter 7, Scheduling and Notices of OCPM Division III: Part C Organization Hearing. This new chapter describes the Determinations scheduling and notice of hearing process for requests for hearing filed Chapter 4, Administrative Record. following reconsideration of Medicare This new chapter describes the eligibility and entitlement, Part B late minimum organization and exhibiting VerDate Sep<11>2014 17:06 Feb 22, 2016 Jkt 238001 PO 00000 Frm 00076 Fmt 4703 Sfmt 4703 enrollment penalties, and Part B and Part D IRMAAs issued by SSA. The chapter also provides guidance on sending amended notices of hearing, rescheduling or cancelling hearings and issuing notices for supplemental hearings. Chapter 13, Closing the Case. This new chapter describes the necessary administrative steps to finalize and close a case on appeal at OMHA following reconsideration of Medicare eligibility and entitlement, Part B late enrollment penalties, and Part B and Part D IRMAAs issued by SSA. The chapter also provides guidance on mailing the notice of disposition and shipping the case file. Dated: February 8, 2016. Jason M. Green, Chief Advisor, Office of Medicare Hearings and Appeals. [FR Doc. 2016–03634 Filed 2–22–16; 8:45 am] BILLING CODE 4152–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Center for Scientific Review; Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. App.), notice is hereby given of the following meetings. The meetings will be closed to the public in accordance with the provisions set forth in sections 552b(c)(4) and 552b(c)(6), Title 5 U.S.C., as amended. The grant applications and the discussions could disclose confidential trade secrets or commercial property such as patentable material, and personal information concerning individuals associated with the grant applications, the disclosure of which would constitute a clearly unwarranted invasion of personal privacy. Name of Committee: Center for Scientific Review Special Emphasis Panel; Member Conflict: Ethology, Addiction and Development. Date: March 14, 2016. Time: 11:00 a.m. to 1:00 p.m. Agenda: To review and evaluate grant applications. Place: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Virtual Meeting). Contact Person: Wind Cowles, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive Room 3172, Bethesda, MD 20892, cowleshw@csr.nih.gov. Name of Committee: Center for Scientific Review Special Emphasis Panel; Small Business: Cardiovascular Sciences. E:\FR\FM\23FEN1.SGM 23FEN1

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[Federal Register Volume 81, Number 35 (Tuesday, February 23, 2016)]
[Notices]
[Pages 8969-8970]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-03634]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

[OMHA-1503-N]


Medicare Program; Administrative Law Judge Hearing Program for 
Medicare Claim and Entitlement Appeals; Quarterly Listing of Program 
Issuances--October Through December 2015

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

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This quarterly notice lists of the OMHA Case Processing Manual 
(OCPM) manual instructions that were published from October through 
December, 2015. This manual standardizes the day-to-day procedures for 
carrying out adjudicative functions, in accordance with applicable 
statutes, regulations and OMHA directives, and gives OMHA staff 
direction for processing appeals at the OMHA level of adjudication.

FOR FURTHER INFORMATION CONTACT: Amanda Axeen, by telephone at (571) 
777-2705, or by email at amanda.axeen@hhs.gov.

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, 
organization and coverage determination, and entitlement appeals under 
sections 1869, 1155, 1876(c)(5)(B), 1852(g)(5), and 1860D-4(h) of the 
Social Security Act (the Act). OMHA ensures that Medicare beneficiaries 
and the providers and suppliers that furnish items or services to 
Medicare beneficiaries, as well as Medicare Advantage Organizations 
(MAOs) and Medicaid State Agencies, have a fair and impartial forum to 
address disagreements with Medicare coverage and payment determinations 
made by Medicare contractors, MAOs, or Part D Plan Sponsors (PDPSs), 
and determinations related to Medicare eligibility and entitlement, 
Part B late enrollment penalty, and income-related monthly adjustment 
amounts (IRMAA) made by the Social Security Administration (SSA).
    The Medicare claim, organization and coverage determination appeals 
processes consist of four levels of administrative review, and a fifth 
level of review with the Federal district courts after administrative 
remedies under HHS regulations have been exhausted. The first two 
levels of review are administered by the Centers for Medicare & 
Medicaid Services (CMS) and conducted by Medicare contractors for claim 
appeals, by MAOs and an independent review entity for Part C 
organization determination appeals, or by PDPSs and an independent 
review entity for Part D coverage determination appeals. The third 
level of review is administered by OMHA and conducted by Administrative 
Law Judges. The fourth level of review is administered by the HHS 
Departmental Appeals Board (DAB) and conducted by the Medicare Appeals 
Council. In addition, OMHA and the DAB administer the second and third 
levels of appeal, respectively, for Medicare eligibility, entitlement, 
Part B late enrollment penalty, and IRMAA reconsiderations made by SSA; 
a fourth level of review with the Federal district courts is available 
after administrative remedies within SSA and HHS have been exhausted.
    Sections 1869, 1155, 1876(c)(5)(B), 1852(g)(5), and 1860D-4(h) of 
the Act are implemented through the regulations at 42 CFR part 405 
subparts I and J; part 417, subpart Q; part 422, subpart M; part 423, 
subparts M and U; and part 478, subpart B. As noted above, OMHA 
administers the nationwide Administrative Law Judge hearing program in 
accordance with these statutes and applicable regulations. As part of 
that effort, OMHA is establishing a manual, the OMHA Case Processing 
Manual (OCPM). Through the OCPM, the OMHA Chief Administrative Law 
Judge establishes the day-to-day procedures for carrying out 
adjudicative functions, in accordance with applicable statutes, 
regulations and OMHA directives. The OCPM provides direction for 
processing appeals at the OMHA level of adjudication for Medicare Part 
A and B claims; Part C organization determinations; Part D coverage 
determinations; and SSA eligibility and entitlement, Part B late 
enrollment penalty, and IRMAA determinations.
    Section 1871(c) of the Act requires that we publish a list of all 
Medicare manual instructions, interpretive rules, statements of policy, 
and guidelines of general applicability not issued as regulations at 
least every 3 months in the Federal Register.

II. Format for the Quarterly Issuance Notices

    This quarterly notice provides the specific updates to the OCPM 
that have occurred in the 3-month period. A hyperlink to the available 
chapters on the OMHA Web site is provided below. The OMHA Web site 
contains the most current, up-to-date chapters and revisions to 
chapters, and will be available earlier than we publish our quarterly 
notice. We believe the OMHA Web site list provides more timely access 
to the current OCPM chapters for those involved in the Medicare claim, 
organization and coverage determination and entitlement appeals 
processes. We also believe the Web site offers the public a more 
convenient tool for real time access to current OCPM provisions. In 
addition, OMHA has a listserv to which the public can subscribe to 
receive immediate notification of any updates to the OMHA Web site. 
This listserv avoids the need to check the OMHA Web site, as update 
notifications are sent to subscribers as they occur. If accessing the 
OMHA Web site proves to be difficult, the contact person listed above 
can provide the information.

III. How To Use the Notice

    This notice lists the OCPM chapters and subjects published during 
the quarter covered by the notice so the

[[Page 8970]]

reader may determine whether any are of particular interest. We expect 
this notice to be used in concert with the previously published 
notices. The OCPM can be accessed at https://www.hhs.gov/omha/OMHA_Case_Processing_Manual/.

IV. OCPM Releases for October Through December 2015

    The OCPM is used by OMHA adjudicators and staff to administer the 
OMHA program. It offers day-to-day operating instructions, policies, 
and procedures based on statutes and regulations, and OMHA directives.
    The following is a list and description of new OCPM provisions and 
the subject matter that have been implemented in the covered 3-month 
period. The full text of current OCPM provisions is available on our 
Web site at https://www.hhs.gov/omha/OMHA_Case_Processing_Manual/.

OCPM Division I: General Matters

    Chapter 7, Adjudication Time Frames. This new chapter describes the 
cases subject to statutory time frames, tolling and waivers of 
adjudication time frames, and provides instruction on how to handle 
cases escalated from the Qualified Independent Contractor (QIC) to OMHA 
and from OMHA to the Medicare Appeals Council.

OCPM Division II: Part A/B Claim Determinations

    Chapter 4, Administrative Record. This new chapter describes the 
minimum organization and exhibiting structure for documents and 
evidence received in support of Medicare Part A and B requests for 
hearing filed with OMHA. This chapter standardizes the way that OMHA 
prepares these files for further processing.
    Chapter 7, Scheduling and Notices of Hearing. This new chapter 
describes the scheduling and notice of hearing process in Medicare Part 
A and Part B cases and provides guidance on sending amended notices of 
hearing, rescheduling or cancelling hearings and issuing notices for 
supplemental hearings.
    Chapter 13, Closing the Case. This new chapter describes the 
necessary administrative steps to finalize and close a Medicare Part A 
or Part B case. The chapter also provides guidance on mailing the 
notice of disposition and shipping the case file.

OCPM Division III: Part C Organization Determinations

    Chapter 4, Administrative Record. This new chapter describes the 
minimum organization and exhibiting structure for documents and 
evidence received in support of Medicare Part C requests for hearing 
filed with OMHA. This chapter standardizes the way that OMHA prepares 
these files for further processing.
    Chapter 7, Scheduling and Notices of Hearing. This new chapter 
describes the scheduling and notice of hearing process in Medicare C 
cases and provides guidance on sending amended notices of hearing, 
rescheduling or cancelling hearings and issuing notices for 
supplemental hearings.
    Chapter 13, Closing the Case. This new chapter describes the 
necessary administrative steps to finalize and close a Medicare Part C 
case. The chapter also provides guidance on mailing the notice of 
disposition and shipping the case file.

OCPM Division IV: Part D Coverage Determinations

    Chapter 4, Administrative Record. This new chapter describes the 
minimum organization and exhibiting structure for documents and 
evidence received in support of Medicare Part D requests for hearing 
filed with OMHA. This chapter standardizes the way that OMHA prepares 
these files for further processing.
    Chapter 7, Scheduling and Notices of Hearing. This new chapter 
describes the scheduling and notice of hearing process in Medicare D 
cases and provides guidance on sending amended notices of hearing, 
rescheduling or cancelling hearings and issuing notices for 
supplemental hearings.
    Chapter 13, Closing the Case. This new chapter describes the 
necessary administrative steps to finalize and close a Medicare Part D 
case. The chapter also provides guidance on mailing the notice of 
disposition and shipping the case file.

OCPM Division V: SSA Determinations

    Chapter 4, Administrative Record. This new chapter describes the 
minimum organization and exhibiting structure for documents and 
evidence received in support of requests for hearing filed with OMHA 
following reconsiderations of Medicare eligibility and entitlement, 
Part B late enrollment penalties, and Part B and Part D IRMAAs issued 
by SSA. This chapter standardizes the way that OMHA prepares these 
files for further processing.
    Chapter 7, Scheduling and Notices of Hearing. This new chapter 
describes the scheduling and notice of hearing process for requests for 
hearing filed following reconsideration of Medicare eligibility and 
entitlement, Part B late enrollment penalties, and Part B and Part D 
IRMAAs issued by SSA. The chapter also provides guidance on sending 
amended notices of hearing, rescheduling or cancelling hearings and 
issuing notices for supplemental hearings.
    Chapter 13, Closing the Case. This new chapter describes the 
necessary administrative steps to finalize and close a case on appeal 
at OMHA following reconsideration of Medicare eligibility and 
entitlement, Part B late enrollment penalties, and Part B and Part D 
IRMAAs issued by SSA. The chapter also provides guidance on mailing the 
notice of disposition and shipping the case file.

    Dated: February 8, 2016.
Jason M. Green,
Chief Advisor, Office of Medicare Hearings and Appeals.
[FR Doc. 2016-03634 Filed 2-22-16; 8:45 am]
 BILLING CODE 4152-01-P
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