Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim and Entitlement Appeals; Quarterly Listing of Program Issuances-July Through September 2018, 56859-56860 [2018-24722]
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Federal Register / Vol. 83, No. 220 / Wednesday, November 14, 2018 / Notices
Dated: November 7, 2018.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2018–24763 Filed 11–13–18; 8:45 am]
BILLING CODE 4164–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
[OMHA–1802–N]
Medicare Program; Administrative Law
Judge Hearing Program for Medicare
Claim and Entitlement Appeals;
Quarterly Listing of Program
Issuances—July Through September
2018
Office of Medicare Hearings
and Appeals (OMHA), HHS.
ACTION: Notice.
AGENCY:
This quarterly notice lists the
OMHA Case Processing Manual (OCPM)
instructions that were published from
July through September 2018. 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:
Jason Green, by telephone at (571) 777–
2723, or by email at jason.green@
hhs.gov.
SUMMARY:
SUPPLEMENTARY INFORMATION:
I. Background
The Office of Medicare Hearings and
Appeals (OMHA), a staff division within
the Office of the Secretary within the
U.S. Department of Health and Human
Services (HHS), administers the
nationwide Administrative Law Judge
hearing program for Medicare claim;
organization, coverage, and at-risk
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), Medicaid State agencies, and
applicable plans, 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)
VerDate Sep<11>2014
18:29 Nov 13, 2018
Jkt 247001
made by the Social Security
Administration (SSA).
The Medicare claim, organization
determination, coverage determination,
and at-risk 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
and at-risk determination appeals. The
third level of review is administered by
OMHA and conducted by
Administrative Law Judges and attorney
adjudicators. The fourth level of review
is administered by the HHS
Departmental Appeals Board (DAB) and
conducted by the Medicare Appeals
Council (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. To
help ensure nationwide consistency in
that effort, OMHA established a manual,
the 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 at-risk
determinations; and SSA eligibility and
entitlement, Part B late enrollment
penalty, and IRMAA determinations.
Section 1871(c) of the Act requires
that the Secretary publish a list of all
Medicare manual instructions,
interpretive rules, statements of policy,
PO 00000
Frm 00062
Fmt 4703
Sfmt 4703
56859
and guidelines of general applicability
not issued as regulations at least every
three 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 three-month period of
July through September 2018. A
hyperlink to the available chapters on
the OMHA website is provided below.
The OMHA website 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
website provides more timely access to
the current OCPM chapters for those
involved in the Medicare claim;
organization, coverage, and at-risk
determination; and entitlement appeals
processes. We also believe the website
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 notification of
certain updates to the OMHA website,
including when new or revised OCPM
chapters are posted. If accessing the
OMHA website 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
reader may determine whether any are
of particular interest. We expect this
notice to be used in concert with future
published notices. The OCPM can be
accessed at https://www.hhs.gov/about/
agencies/omha/the-appeals-process/
case-processing-manual/.
IV. OCPM Releases for July Through
September 2018
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 OCPM provisions that were revised in
the three-month period of July through
September 2018. This information is
available on our website at https://
www.hhs.gov/about/agencies/omha/theappeals-process/case-processingmanual/.
OCPM Chapter 5: Representatives
Chapter 5, Representatives. This
chapter describes the role of
representatives in the appeals process,
including the documentation required
E:\FR\FM\14NON1.SGM
14NON1
56860
Federal Register / Vol. 83, No. 220 / Wednesday, November 14, 2018 / Notices
to establish a valid representation,
representative rights and
responsibilities, communications with
representatives and represented parties,
and changes of representative due to
delegation, revocation, or termination of
an appointment. This chapter also
discusses the fee approval process for
representatives and the circumstances
under which an eligible individual or
entity may be entitled to reasonable
attorney fees and other expenses under
the Equal Access to Justice Act.
OCPM Chapter 6: CMS, CMS Contractor,
and Plan Roles
Chapter 6, CMS, CMS Contractor, and
Plan Roles. This chapter describes when
and how CMS, a CMS contractor, or a
plan (for example, a Medicare
Advantage organization or Part D plan
sponsor) may join the proceedings on a
request for hearing as a party or as a
non-party participant. This chapter also
describes the requirements for a valid
election or request to participate in the
proceedings, and the circumstances
under which an election may be deemed
invalid or a request may be denied. This
chapter also discusses when evidence,
position papers, and written testimony
may be submitted by CMS, a CMS
contractor, or a plan.
OCPM Chapter 7: Adjudication Time
Frames, Case Prioritization, and
Escalations
Chapter 7, Adjudication Time Frames,
Case Prioritization, and Escalations.
This chapter describes the time frames
for an adjudicator to issue a decision,
dismissal, or remand in an appeal. This
chapter also addresses when an
adjudication time frame may be delayed
or extended, and how it can be waived
by the appellant. This chapter discusses
OMHA’s case prioritization policy,
which determines the general order in
which appeals are processed. Lastly,
this chapter describes the types of
appeal that may be escalated to the
Medicare Appeals Council when an
adjudicator is unable to issue a decision,
dismissal, or remand within an
applicable adjudication time frame, and
the requirements for a valid request for
escalation.
OCPM Chapter 14: Scheduling and
Noticing for Prehearing Conferences and
Hearings
Chapter 14, Scheduling and Noticing
for Prehearing Conferences and
Hearings. This chapter describes the
process for scheduling and providing
notice of prehearing conferences and
hearings, the actions that must be
completed before a hearing is
scheduled, and the circumstances when
VerDate Sep<11>2014
22:42 Nov 13, 2018
Jkt 247001
a hearing is required. This chapter also
identifies the parties, potential parties,
and participants to whom notices must
be sent, and how to address responses
to these notices and any objections or
requests that may be made by the notice
recipients. Finally, this chapter
discusses the circumstances in which a
hearing may be rescheduled or
canceled, and when a supplemental
hearing may be necessary.
Dated: November 6, 2018.
Jason M. Green,
Chief Advisor, Office of Medicare Hearings
and Appeals.
[FR Doc. 2018–24722 Filed 11–13–18; 8:45 am]
BILLING CODE 4150–46–P
DEPARTMENT OF HOMELAND
SECURITY
U.S. Customs and Border Protection
[1651–0110]
Agency Information Collection
Activities: Visa Waiver Program Carrier
Agreement
U.S. Customs and Border
Protection (CBP), Department of
Homeland Security.
ACTION: 30-Day notice and request for
comments; extension of an existing
collection of information.
AGENCY:
The Department of Homeland
Security, U.S. Customs and Border
Protection will be submitting the
following information collection request
to the Office of Management and Budget
(OMB) for review and approval in
accordance with the Paperwork
Reduction Act of 1995 (PRA). The
information collection is published in
the Federal Register to obtain comments
from the public and affected agencies.
Comments are encouraged and will be
accepted (no later than December 14,
2018) to be assured of consideration.
ADDRESSES: Interested persons are
invited to submit written comments on
this proposed information collection to
the Office of Information and Regulatory
Affairs, Office of Management and
Budget. Comments should be addressed
to the OMB Desk Officer for Customs
and Border Protection, Department of
Homeland Security, and sent via
electronic mail to dhsdeskofficer@
omb.eop.gov.
FOR FURTHER INFORMATION CONTACT:
Requests for additional PRA information
should be directed to Seth Renkema,
Chief, Economic Impact Analysis
Branch, U.S. Customs and Border
Protection, Office of Trade, Regulations
and Rulings, 90 K Street NE, 10th Floor,
SUMMARY:
PO 00000
Frm 00063
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Sfmt 4703
Washington, DC 20229–1177,
Telephone number (202) 325–0056 or
via email CBP_PRA@cbp.dhs.gov. Please
note that the contact information
provided here is solely for questions
regarding this notice. Individuals
seeking information about other CBP
programs should contact the CBP
National Customer Service Center at
877–227–5511, (TTY) 1–800–877–8339,
or CBP website at https://www.cbp.
gov/.
SUPPLEMENTARY INFORMATION: CBP
invites the general public and other
Federal agencies to comment on the
proposed and/or continuing information
collections pursuant to the Paperwork
Reduction Act of 1995 (44 U.S.C. 3501
et seq.). This proposed information
collection was previously published in
the Federal Register (Volume 83 FR
Page 35674) on July 27, 2018, allowing
for a 60-day comment period. This
notice allows for an additional 30 days
for public comments. This process is
conducted in accordance with 5 CFR
1320.8. Written comments and
suggestions from the public and affected
agencies should address one or more of
the following four points: (1) Whether
the proposed collection of information
is necessary for the proper performance
of the functions of the agency, including
whether the information will have
practical utility; (2) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information,
including the validity of the
methodology and assumptions used; (3)
suggestions to enhance the quality,
utility, and clarity of the information to
be collected; and (4) suggestions to
minimize the burden of the collection of
information on those who are to
respond, including through the use of
appropriate automated, electronic,
mechanical, or other technological
collection techniques or other forms of
information technology, e.g., permitting
electronic submission of responses. The
comments that are submitted will be
summarized and included in the request
for approval. All comments will become
a matter of public record.
Overview of This Information
Collection
Title: Visa Waiver Program Carrier
Agreement.
OMB Number: 1651–0110.
Form Number: CBP Form I–775.
Current Actions: This submission is
being made to extend the expiration
date with a decrease in burden hours
due to updated agency estimates on
respondents. There is no change to
information collected or to CBP Form I–
775.
E:\FR\FM\14NON1.SGM
14NON1
]]>Agencies
[Federal Register Volume 83, Number 220 (Wednesday, November 14, 2018)]
[Notices]
[Pages 56859-56860]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-24722]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
[OMHA-1802-N]
Medicare Program; Administrative Law Judge Hearing Program for
Medicare Claim and Entitlement Appeals; Quarterly Listing of Program
Issuances--July Through September 2018
AGENCY: Office of Medicare Hearings and Appeals (OMHA), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This quarterly notice lists the OMHA Case Processing Manual
(OCPM) instructions that were published from July through September
2018. 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: Jason Green, by telephone at (571)
777-2723, or by email at [email protected].
SUPPLEMENTARY INFORMATION:
I. Background
The Office of Medicare Hearings and Appeals (OMHA), a staff
division within the Office of the Secretary within the U.S. Department
of Health and Human Services (HHS), administers the nationwide
Administrative Law Judge hearing program for Medicare claim;
organization, coverage, and at-risk 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), Medicaid State agencies, and applicable
plans, 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 determination, coverage
determination, and at-risk 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 and at-risk determination appeals. The third
level of review is administered by OMHA and conducted by Administrative
Law Judges and attorney adjudicators. The fourth level of review is
administered by the HHS Departmental Appeals Board (DAB) and conducted
by the Medicare Appeals Council (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. To help
ensure nationwide consistency in that effort, OMHA established a
manual, the 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 at-risk determinations; and SSA eligibility and
entitlement, Part B late enrollment penalty, and IRMAA determinations.
Section 1871(c) of the Act requires that the Secretary 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 three 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 three-month period of July through September
2018. A hyperlink to the available chapters on the OMHA website is
provided below. The OMHA website 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 website provides
more timely access to the current OCPM chapters for those involved in
the Medicare claim; organization, coverage, and at-risk determination;
and entitlement appeals processes. We also believe the website 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 notification of certain updates to the OMHA
website, including when new or revised OCPM chapters are posted. If
accessing the OMHA website 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 reader may determine whether
any are of particular interest. We expect this notice to be used in
concert with future published notices. The OCPM can be accessed at
https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/.
IV. OCPM Releases for July Through September 2018
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 OCPM provisions that
were revised in the three-month period of July through September 2018.
This information is available on our website at https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/.
OCPM Chapter 5: Representatives
Chapter 5, Representatives. This chapter describes the role of
representatives in the appeals process, including the documentation
required
[[Page 56860]]
to establish a valid representation, representative rights and
responsibilities, communications with representatives and represented
parties, and changes of representative due to delegation, revocation,
or termination of an appointment. This chapter also discusses the fee
approval process for representatives and the circumstances under which
an eligible individual or entity may be entitled to reasonable attorney
fees and other expenses under the Equal Access to Justice Act.
OCPM Chapter 6: CMS, CMS Contractor, and Plan Roles
Chapter 6, CMS, CMS Contractor, and Plan Roles. This chapter
describes when and how CMS, a CMS contractor, or a plan (for example, a
Medicare Advantage organization or Part D plan sponsor) may join the
proceedings on a request for hearing as a party or as a non-party
participant. This chapter also describes the requirements for a valid
election or request to participate in the proceedings, and the
circumstances under which an election may be deemed invalid or a
request may be denied. This chapter also discusses when evidence,
position papers, and written testimony may be submitted by CMS, a CMS
contractor, or a plan.
OCPM Chapter 7: Adjudication Time Frames, Case Prioritization, and
Escalations
Chapter 7, Adjudication Time Frames, Case Prioritization, and
Escalations. This chapter describes the time frames for an adjudicator
to issue a decision, dismissal, or remand in an appeal. This chapter
also addresses when an adjudication time frame may be delayed or
extended, and how it can be waived by the appellant. This chapter
discusses OMHA's case prioritization policy, which determines the
general order in which appeals are processed. Lastly, this chapter
describes the types of appeal that may be escalated to the Medicare
Appeals Council when an adjudicator is unable to issue a decision,
dismissal, or remand within an applicable adjudication time frame, and
the requirements for a valid request for escalation.
OCPM Chapter 14: Scheduling and Noticing for Prehearing Conferences and
Hearings
Chapter 14, Scheduling and Noticing for Prehearing Conferences and
Hearings. This chapter describes the process for scheduling and
providing notice of prehearing conferences and hearings, the actions
that must be completed before a hearing is scheduled, and the
circumstances when a hearing is required. This chapter also identifies
the parties, potential parties, and participants to whom notices must
be sent, and how to address responses to these notices and any
objections or requests that may be made by the notice recipients.
Finally, this chapter discusses the circumstances in which a hearing
may be rescheduled or canceled, and when a supplemental hearing may be
necessary.
Dated: November 6, 2018.
Jason M. Green,
Chief Advisor, Office of Medicare Hearings and Appeals.
[FR Doc. 2018-24722 Filed 11-13-18; 8:45 am]
BILLING CODE 4150-46-P
