Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim and Entitlement Appeals; Quarterly Listing of Program Issuances-April Through June 2019, 33956-33957 [2019-15151]
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Federal Register / Vol. 84, No. 136 / Tuesday, July 16, 2019 / Notices
Maria G. Button,
Director, Division of the Executive Secretariat.
[FR Doc. 2019–15007 Filed 7–15–19; 8:45 am]
BILLING CODE 4165–15–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
[OMHA–1902–N]
Medicare Program; Administrative Law
Judge Hearing Program for Medicare
Claim and Entitlement Appeals;
Quarterly Listing of Program
Issuances—April Through June 2019
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
April through June 2019. 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:
jspears on DSK30JT082PROD with NOTICES
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).
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20:36 Jul 15, 2019
Jkt 247001
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 (IRE) for
Part C organization determination
appeals, or by PDPSs and an IRE 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
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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
April through June 2019. A hyperlink to
the available chapters on the OMHA
website is provided below. The OMHA
website contains the most current, upto-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. The OCPM can be
accessed at https://www.hhs.gov/about/
agencies/omha/the-appeals-process/
case-processing-manual/.
IV. OCPM Releases for April Through
June 2019
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 issued or
revised in the three-month period of
April through June 2019. This
information is available on our website
at https://www.hhs.gov/about/agencies/
omha/the-appeals-process/caseprocessing-manual/.
OCPM Chapter 11: Procedural Review
and Determinations
This newly issued chapter describes
how to conduct a procedural review of
an appeal, and how to resolve any
identified procedural defects. The
procedural review is required to ensure
that a request for hearing or review of
dismissal meets jurisdictional and filing
E:\FR\FM\16JYN1.SGM
16JYN1
Federal Register / Vol. 84, No. 136 / Tuesday, July 16, 2019 / Notices
requirements, and that procedural
determinations are made before case
development occurs, or a conference or
hearing is scheduled. If there is a
procedural defect, the defect may result
in a dismissal or may require an
opportunity for the appellant to resolve
the defect. If an adjudication time frame
applies to the case, a procedural defect
may delay the start of, or extend, the
adjudication time frame. When the
procedural review is complete, and any
identified defects have been resolved,
and any applicable determinations have
been made, the case moves forward in
the adjudication process. Specialized
procedural review is required for
requests for expedited hearings in Part
D appeals; however, a hearing may be
scheduled before the screening is
complete and any procedural defects are
resolved, to facilitate meeting the
expedited adjudication period.
jspears on DSK30JT082PROD with NOTICES
OCPM Chapter 6: CMS, CMS Contractor,
Plan Roles—Sections 6.3.1.1, 6.3.2
This chapter was initially released on
July 27, 2018, and was included in a
quarterly notice published in the
November 14, 2018 Federal Register (83
FR 56859). Sections 6.3.1.1 and 6.3.2 of
this chapter state that a Unified Program
Integrity Contractor (UPIC) cannot elect
party status in an appeal, and may only
participate as a non-party. As initially
published, these sections cited to CMS’s
Medicare Program Integrity Manual,
internet-only manual publication 100–
08, chapter 4, section 4.8.2, which
previously stated that a Zone Program
Integrity Contractor (ZPIC) could not
elect party status in an appeal, and
section 4.1, which stated that all
references to ZPICs shall also apply to
UPICs, unless otherwise specified in the
UPIC Statement of Work (SOW).
Effective October 22, 2018, CMS revised
the Medicare Program Integrity Manual
to directly state that a UPIC cannot
invoke party status, and can only
participate in OMHA proceedings as a
non-party. This revision to OCPM
6.3.1.1 and 6.3.2 updates footnotes in
these sections to reflect the CMS
manual’s revised language. This
revision does not change the way that
OMHA interprets or implements the
underlying policy that a UPIC cannot
elect party status.
Dated: July 2, 2019.
Karen W. Ames,
Executive Director, Office of Medicare
Hearings and Appeals.
[FR Doc. 2019–15151 Filed 7–15–19; 8:45 am]
BILLING CODE 4150–46–P
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17:33 Jul 15, 2019
Jkt 247001
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
Notice To Announce Request for
Information on the Development of the
National Institute of Dental and
Craniofacial Research’s Strategic Plan
for Fiscal Years 2020–2025
AGENCY:
National Institutes of Health,
HHS.
ACTION:
Notice.
The National Institute of
Dental and Craniofacial Research
(NIDCR) is drafting its Strategic Plan for
Fiscal Years (FY) 2020–2025 to help
guide the research it supports over the
next six years. NIDCR 2030 established
five priority areas and accompanying
goals, which we’re now using to
organize the 2020–2025 Strategic Plan.
Through this Request for Information,
NIDCR invites researchers in academia
and industry, health care professionals,
patient advocates and health advocacy
organizations, scientific or professional
organizations, Federal agencies, and
other interested members of the public
to provide feedback on NIDCR’s next
strategic plan.
DATES: The NIDCR’s Request for
Information is open for public comment
for a period of 30 days. Comments must
be received by August 15, 2019, to
ensure consideration. After the public
comment period has closed, the
comments received by the NIDCR will
be considered in a timely manner for the
development of the FY 2020–2025
National Institute of Dental and
Craniofacial Research’s Strategic Plan.
ADDRESSES: Please visit our website to
view the priority areas and provide your
feedback electronically: https://
www.nidcr.nih.gov/about-us/strategicplan/2020-2025-nidcr-strategic-plan.
Feedback can also be submitted via
email (NIDCRstrategicPlan@
nidcr.nih.gov).
SUMMARY:
D.
Jonathan Horsford, Ph.D. Acting
Director, Office of Science Policy and
Analysis, National Institute of Dental
and Craniofacial Research, NIH, 31
Center Drive, Suite 5B55, Bethesda, MD
20892. Email: Jonathan.Horsford@
NIH.gov.
FOR FURTHER INFORMATION CONTACT:
The
National Institute of Dental and
Craniofacial Research’s (NIDCR) mission
is to improve the health of the nation
through investments in research focused
on dental, oral, and craniofacial (DOC)
diseases including caries, periodontal
disease, cancers, orofacial pain,
SUPPLEMENTARY INFORMATION:
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33957
craniofacial disorders, salivary gland
disorders, rare diseases, and oral
manifestations of systemic diseases. In
2017, NIDCR launched NIDCR 2030, a
visioning initiative where we imagined
a future world in which DOC health and
diseases are understood in the context
of the whole body and research
transforms how we promote health, treat
disease, and overcome health
disparities. To get us there, NIDCR
requests your help in developing our
2020–2025 Strategic Plan.
Dated: July 9, 2019.
Martha J. Somerman,
Director, National Institute of Dental and
Craniofacial Research, National Institutes of
Health.
[FR Doc. 2019–15006 Filed 7–15–19; 8:45 am]
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DEPARTMENT OF HOMELAND
SECURITY
Coast Guard
[Docket No. USCG–2019–0258]
Collection of Information Under
Review by Office of Management and
Budget; OMB Control Number: 1625–
0048
Coast Guard, DHS.
Thirty-day notice requesting
comments.
AGENCY:
ACTION:
In compliance with the
Paperwork Reduction Act of 1995 the
U.S. Coast Guard is forwarding an
Information Collection Request (ICR),
abstracted below, to the Office of
Management and Budget (OMB), Office
of Information and Regulatory Affairs
(OIRA), requesting approval for
reinstatement, without change, of the
following collection of information:
1625–0048, Vessel Reporting
Requirements. Our ICR describes the
information we seek to collect from the
public. Review and comments by OIRA
ensure we only impose paperwork
burdens commensurate with our
performance of duties.
DATES: Comments must reach the Coast
Guard and OIRA on or before August 15,
2019.
ADDRESSES: You may submit comments
identified by Coast Guard docket
number [USCG–2019–0258] to the Coast
Guard using the Federal eRulemaking
Portal at https://www.regulations.gov.
Alternatively, you may submit
comments to OIRA using one of the
following means:
(1) Email: OIRA-submission@
omb.eop.gov.
SUMMARY:
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]]>Agencies
[Federal Register Volume 84, Number 136 (Tuesday, July 16, 2019)]
[Notices]
[Pages 33956-33957]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-15151]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
[OMHA-1902-N]
Medicare Program; Administrative Law Judge Hearing Program for
Medicare Claim and Entitlement Appeals; Quarterly Listing of Program
Issuances--April Through June 2019
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 April through June 2019.
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 (IRE) for Part C organization determination
appeals, or by PDPSs and an IRE 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 April through June
2019. 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. The OCPM can be accessed at https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/.
IV. OCPM Releases for April Through June 2019
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 issued or revised in the three-month period of April through June
2019. This information is available on our website at https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/.
OCPM Chapter 11: Procedural Review and Determinations
This newly issued chapter describes how to conduct a procedural
review of an appeal, and how to resolve any identified procedural
defects. The procedural review is required to ensure that a request for
hearing or review of dismissal meets jurisdictional and filing
[[Page 33957]]
requirements, and that procedural determinations are made before case
development occurs, or a conference or hearing is scheduled. If there
is a procedural defect, the defect may result in a dismissal or may
require an opportunity for the appellant to resolve the defect. If an
adjudication time frame applies to the case, a procedural defect may
delay the start of, or extend, the adjudication time frame. When the
procedural review is complete, and any identified defects have been
resolved, and any applicable determinations have been made, the case
moves forward in the adjudication process. Specialized procedural
review is required for requests for expedited hearings in Part D
appeals; however, a hearing may be scheduled before the screening is
complete and any procedural defects are resolved, to facilitate meeting
the expedited adjudication period.
OCPM Chapter 6: CMS, CMS Contractor, Plan Roles--Sections 6.3.1.1,
6.3.2
This chapter was initially released on July 27, 2018, and was
included in a quarterly notice published in the November 14, 2018
Federal Register (83 FR 56859). Sections 6.3.1.1 and 6.3.2 of this
chapter state that a Unified Program Integrity Contractor (UPIC) cannot
elect party status in an appeal, and may only participate as a non-
party. As initially published, these sections cited to CMS's Medicare
Program Integrity Manual, internet-only manual publication 100-08,
chapter 4, section 4.8.2, which previously stated that a Zone Program
Integrity Contractor (ZPIC) could not elect party status in an appeal,
and section 4.1, which stated that all references to ZPICs shall also
apply to UPICs, unless otherwise specified in the UPIC Statement of
Work (SOW). Effective October 22, 2018, CMS revised the Medicare
Program Integrity Manual to directly state that a UPIC cannot invoke
party status, and can only participate in OMHA proceedings as a non-
party. This revision to OCPM 6.3.1.1 and 6.3.2 updates footnotes in
these sections to reflect the CMS manual's revised language. This
revision does not change the way that OMHA interprets or implements the
underlying policy that a UPIC cannot elect party status.
Dated: July 2, 2019.
Karen W. Ames,
Executive Director, Office of Medicare Hearings and Appeals.
[FR Doc. 2019-15151 Filed 7-15-19; 8:45 am]
BILLING CODE 4150-46-P
