Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim and Entitlement Appeals; Quarterly Listing of Program Issuances-October 2019 Through March 2020, 39571-39573 [2020-14203]
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Federal Register / Vol. 85, No. 127 / Wednesday, July 1, 2020 / Notices
1. Type of Information Collection
Request: Revision with change of a
currently approved collection; Title of
Information Collection: HEDIS® Data
Collection for Medicare Advantage; Use:
The HEDIS® data collection supports
the CMS strategic goal of improving the
quality of care and health status for
Medicare beneficiaries. The HEDIS®
measures are part of the Medicare Part
C Star Ratings as described at
§§ 422.160, 422.162, 422.164, and
422.166. CMS publishes the Medicare
Part C Star Ratings each year to: (1)
Incentivize quality improvement in
Medicare Advantage (MA); and (2) assist
beneficiaries in finding the best plan for
them. The ratings feed into MA Quality
Bonus Payments. The Medicare Star
Ratings support the efforts of CMS to
improve the level of accountability for
the care provided by physicians,
hospitals, and other providers.
HEDIS® data support the agency’s
goal to hold MA contracts accountable
for delivering care in accordance with
widely accepted clinical guidelines and
standards of care. CMS uses HEDIS®
data to obtain the information necessary
for the proper oversight of the Medicare
Advantage program. NCQA trains and
licenses organizations to conduct audits
on-site at the MAOs secure recordkeeping facilities where they compile
their administrative and medical
records for the HEDIS data file
submissions Form Number: CMS–10219
(OMB control number: 0938–1028);
Frequency: Yearly; Affected Public:
Federal Government; Number of
Respondents: 677; Total Annual
Responses: 677; Total Annual Hours:
216,640. (For policy questions regarding
this collection contact Lori Teichman at
410–786–6684.)
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Examination
and Treatment for Emergency Medical
Conditions and Women in Labor
(EMTALA); Use: Pursuant to section
1866(a)(1)(I) of the Act, Congress has
mandated that the Secretary enforce
section 1867 of the Act. Under section
1867, effective August 1, 1986, hospitals
may continue to participate in the
Medicare program only if they are not
out of compliance with its provisions.
Continued Paper Work Reduction Act
(PRA) approval of the regulation
sections cited below will promote
uniform and thorough application of the
section 1866 and 1867 requirements.
They will also provide information
when requested by Congress and other
interested parties regarding the
implementation of the statute. During
2004 through 2018, approximately 8,146
VerDate Sep<11>2014
01:53 Jul 01, 2020
Jkt 250001
complaints were received,
approximately 7,770 of those
complaints were investigated, and
approximately 3,567 EMTALA
deficiencies were found. During Federal
fiscal years 2001 through 2005 the
Inspector General’s Office imposed civil
monetary penalties on hospitals in 105
cases, for a total of $2,645,750 in
penalties. An audit completed by the
Office of Inspector General (OIG)
(entitled, Office of Inspector General:
Implementation and Enforcement of the
Examination and Treatment for
Emergency Medical Conditions and
Women in Labor by the Health Care
Financing Administration, April 1995,
A–06–93–00087) determined that CMS’s
implementation of the Act was generally
effective, but Regional Offices (RO) were
not consistent with conducting timely
investigations, sending
acknowledgments to complaints,
ensuring that investigations were
thorough, or ensuring that violations
were referred to the OIG in accordance
with CMS policy for possible civil
monetary penalty action. OIG further
concluded that without proper
compliance, there is an increased risk
that individuals with emergency
medical conditions will not receive the
treatment needed to stabilize their
condition, which may place them in
greater risk of death. Form Number:
CMS–R–142 (OMB control number:
0938–0667); Frequency: Occasionally;
Affected Public: Private Sector; Business
or other for-profits, Not-for-profit
institutions; Number of Respondents:
5,291; Total Annual Responses: 5,291;
Total Annual Hours: 5,291. (For policy
questions regarding this collection
contact Renate Dombrowski at (410)
786–4645.)
3. Type of Information Collection
Request: New collection of information
request; Title of Information Collection:
Quality Payment Program/Merit-Based
Incentive Payment System (MIPS)
Surveys and Feedback Collections; Use:
The purpose of this submission is to
request approval for generic clearance of
a program of survey and feedback
collections supporting the Quality
Payment Program which includes the
Merit-Based Incentive Payment System
(MIPS) and Advanced Alternative
Payment Models (AAPMs). MIPS is a
program for certain eligible clinicians
that makes Medicare payment
adjustments based on performance on
quality, cost and other measures and
activities, and that consolidates
components of three precursor
programs—the Physician Quality
Reporting system (PQRS), the Value
Modifier (VM), and the Medicare
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39571
Electronic Health Record (EHR)
Incentive Program for eligible
professionals. AAPMs are a track of the
Quality Payment Program that offer
incentives for achieving threshold levels
of payments or patients in Advanced
APMs or Other Payer Advanced APMs.
Under the AAPM path, eligible
clinicians may become Qualifying APM
Participants (QPs) and are excluded
from MIPS. Partial Qualifying APM
Participants (Partial QPs) may opt to
report and be scored under MIPS.
This generic clearance will cover a
program of surveys and feedback
collections designed to strategically
obtain data and feedback from MIPS
eligible clinicians, third-party
intermediaries, Medicare beneficiaries,
and any other audiences that would
support the Agency in improving MIPS
or the Quality Payment Program. The
specific collections we intend to
conduct are: Human Centered Design
(HCD) User Testing Volunteer Sign-Up
Survey; HCD User Satisfaction, Product
Usage, and Benchmarking Surveys; and
Physician Compare (and/or successor
website) User Testing. Form Number:
CMS–10695 (OMB control number:
0938–NEW); Frequency: Occasionally;
Affected Public: Private Sector: Business
or other for-profits and Not-for-profit
institutions and Individuals; Number of
Respondents: 630,300; Total Annual
Responses: 630,300; Total Annual
Hours: 57,950. (For policy questions
regarding this collection, contact
Michelle Peterman at 410–786–2591.)
Dated: June 25, 2020.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2020–14087 Filed 6–30–20; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
[OMHA–1903–N]
Medicare Program; Administrative Law
Judge Hearing Program for Medicare
Claim and Entitlement Appeals;
Quarterly Listing of Program
Issuances—October 2019 Through
March 2020
Office of Medicare Hearings
and Appeals (OMHA), Health and
Human Services (HHS).
ACTION: Notice.
AGENCY:
This notice lists the OMHA
Case Processing Manual (OCPM)
instructions that were published from
October 2019 through March 2020. This
SUMMARY:
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Federal Register / Vol. 85, No. 127 / Wednesday, July 1, 2020 / Notices
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: Jon
Dorman, by telephone at (571) 457–
7220, or by email at jon.dorman@
hhs.gov.
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
VerDate Sep<11>2014
01:53 Jul 01, 2020
Jkt 250001
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 notice provides the specific
updates to the OCPM that have occurred
in the period of October 2019 through
March 2020. 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
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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
period 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 October 2019
Through March 2020
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 period of October 2019
through March 2020. This information
is available on our website at https://
www.hhs.gov/about/agencies/omha/theappeals-process/case-processingmanual/.
OCPM Chapter 16: Decisions
On October 9, 2019, OMHA issued
OCPM Chapter 16, which describes the
structure and content of the decisions
issued by OMHA adjudicators. The
chapter details when an adjudicator
classifies a decision as favorable or fully
favorable, unfavorable, or partially
favorable, and the effect the financial
responsibility determination has on the
characterization of the decision.
Additionally, the chapter provides
general writing guidelines and the
protocols for protecting personally
identifiable and protected health
information in a decision. The chapter
also describes the format for a decision
affirming the dismissal of a request for
reconsideration, a decision addressing
multiple consolidated appeals, and a
stipulated decision. An OMHAapproved notice of decision template
must accompany every decision and
describes the parties’ appeals rights.
OMHA also issued a Citation Policy as
chapter support material to Chapter 16.
OCPM Chapter 15: Conducting
Conferences and Hearings: Posthearing
Development
On November 21, 2019, OMHA issued
OCPM Chapter 15, which describes the
process used by OMHA adjudicators
when conducting prehearing/
E:\FR\FM\01JYN1.SGM
01JYN1
Federal Register / Vol. 85, No. 127 / Wednesday, July 1, 2020 / Notices
posthearing conferences and hearings.
The chapter details regulatory
requirements, OMHA administrative
requirements, and suggested best
practices when conducting a conference
or hearing. The chapter also explains
when and how to hold a consolidated,
supplemental, or continued hearing; the
procedures for responding to a request
for a copy of the administrative record;
and available actions that can be taken
to develop the administrative record
after an initial hearing has been
conducted.
OCPM Chapter 10: Party and Non-Party
Participant Requests and Submissions
On February 19, 2020, OMHA issued
OCPM Chapter 10, which explains how
to route, document and address contacts
from parties and non-party participants
involving both general and case-specific
matters. The chapter describes how to
provide language or communication
assistance services to individuals with
limited English proficiency or a
disability, and summarizes the services
OMHA offers in response to such
requests. The chapter also explains how
to process requests for a stay of
proceedings, discovery, or subpoena;
and review submissions of evidence and
other case-related materials. Many types
of requests and submissions that
generally occur at a specific stage in the
adjudication process are covered in
detail in other OCPM chapters. To
facilitate locating this information,
Chapter 10 contains a list of these
requests and submissions, along with
cross-references to the specific OCPM
provisions where they are discussed.
[FR Doc. 2020–14203 Filed 6–30–20; 8:45 am]
BILLING CODE 4150–46–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
National Institute of Mental Health;
Notice of Closed Meeting
Pursuant to section 10(d) of the
Federal Advisory Committee Act, as
amended, notice is hereby given of the
following meeting.
The meeting 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
01:53 Jul 01, 2020
Jkt 250001
Name of Committee: National Institute of
Mental Health Special Emphasis Panel;
Mental Health Services: Member Conflict.
Date: July 15, 2020.
Time: 11:30 a.m. to 1:30 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health,
Neuroscience Center, 6001 Executive Blvd.,
Rockville, MD 20852 (Telephone Conference
Call).
Contact Person: Karen Gavin-Evans, Ph.D.,
Scientific Review Officer, Division of
Extramural Activities, National Institute of
Mental Health, NIH, Neuroscience Center,
6001 Executive Boulevard, Room 6153, MSC
9606, Bethesda, MD 20892, 301–451–2356,
gavinevanskm@mail.nih.gov.
This notice is being published less than 15
days prior to the meeting due to the timing
limitations imposed by the review and
funding cycle.
(Catalogue of Federal Domestic Assistance
Program No. 93.242, Mental Health Research
Grants, National Institutes of Health, HHS)
Dated: June 26, 2020.
Melanie J. Pantoja,
Program Analyst, Office of Federal Advisory
Committee Policy.
[FR Doc. 2020–14163 Filed 6–30–20; 8:45 am]
BILLING CODE 4140–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
National Institute of Neurological
Disorders and Stroke; Notice of Closed
Meetings
Dated: June 26, 2020.
Karen W. Ames,
Executive Director, Office of Medicare
Hearings and Appeals.
VerDate Sep<11>2014
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.
Pursuant to section 10(d) of the
Federal Advisory Committee Act, as
amended, 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: National Institute of
Neurological Disorders and Stroke Special
Emphasis Panel; Review of RFA NS–20–013
White Matter Lesion Etiology of Dementia in
the U.S. Including in Health Disparity
Populations (U19).
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39573
Date: July 8, 2020.
Time: 9:30 a.m. to 6:30 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health, 6001
Executive Boulevard, Rockville, MD 20852
(Virtual Meeting).
Contact Person: Marilyn Moore-Hoon,
Ph.D., Scientific Review Officer, Scientific
Review Branch, Division of Extramural
Activities, National Institute of Neurological
Disorders and Stroke, Bethesda, MD 20892,
301 827–9087 mooremar@mail.nih.gov.
This notice is being published less than 15
days prior to the meeting due to the timing
limitations imposed by the review and
funding cycle.
Name of Committee: National Institute of
Neurological Disorders and Stroke Special
Emphasis Panel; BRAIN Biology and
Biophysics of Neural Stimulations and
Recording Technologies SRB M01.
Date: July 9, 2020.
Time: 9:30 a.m. to 6:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: Neuroscience Center, 6001
Executive Blvd., North Bethesda, MD 20852
(Video Assisted Meeting).
Contact Person: Mirela Milescu, Ph.D.,
Scientific Review Officer, Scientific Review
Branch, Division of Extramural Activities,
NINDS/NIH, NSC, 6001 Executive Blvd.,
Suite 3208, MSC 9529, Bethesda, MD 20892,
mirela.milescu@nih.gov.
This notice is being published less than 15
days prior to the meeting due to the timing
limitations imposed by the review and
funding cycle.
Name of Committee: National Institute of
Neurological Disorders and Stroke Special
Emphasis Panel; Accelerating Medicine
Partnership in Parkinson’s disease (AMP PD)
data use and analysis (U01).
Date: July 10, 2020.
Time: 9:00 a.m. to 6:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: Neuroscience Center, 6001
Executive Blvd., North Bethesda, MD 20852
(Video Assisted Meeting).
Contact Person: Joel A. Saydoff, Ph.D.,
Scientific Review Officer, Scientific Review
Branch, Division of Extramural Activities,
NINDS/NIH, NSC, 6001 Executive Blvd.,
Room 3205, MSC 9529, Bethesda, MD 20892,
(301) 496–9223, joel.saydoff@nih.gov.
This notice is being published less than 15
days prior to the meeting due to the timing
limitations imposed by the review and
funding cycle.
Name of Committee: National Institute of
Neurological Disorders and Stroke Special
Emphasis Panel; Early Phase Trials &
Comparative Effectiveness Research.
Date: July 10, 2020.
Time: 10:00 a.m. to 3:30 p.m.
Agenda: To review and evaluate grant
applications.
Place: Neuroscience Center, 6001
Executive Blvd., North Bethesda, MD 20852
(Video Assisted Meeting).
Contact Person: Shanta Rajaram, Ph.D.,
Scientific Review Officer, Scientific Review
Branch, Division of Extramural Activities,
E:\FR\FM\01JYN1.SGM
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]]>Agencies
[Federal Register Volume 85, Number 127 (Wednesday, July 1, 2020)]
[Notices]
[Pages 39571-39573]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-14203]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
[OMHA-1903-N]
Medicare Program; Administrative Law Judge Hearing Program for
Medicare Claim and Entitlement Appeals; Quarterly Listing of Program
Issuances--October 2019 Through March 2020
AGENCY: Office of Medicare Hearings and Appeals (OMHA), Health and
Human Services (HHS).
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice lists the OMHA Case Processing Manual (OCPM)
instructions that were published from October 2019 through March 2020.
This
[[Page 39572]]
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: Jon Dorman, by telephone at (571) 457-
7220, 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 notice provides the specific updates to the OCPM that have
occurred in the period of October 2019 through March 2020. 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 period 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 October 2019 Through March 2020
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 period of October 2019 through March
2020. This information is available on our website at https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/.
OCPM Chapter 16: Decisions
On October 9, 2019, OMHA issued OCPM Chapter 16, which describes
the structure and content of the decisions issued by OMHA adjudicators.
The chapter details when an adjudicator classifies a decision as
favorable or fully favorable, unfavorable, or partially favorable, and
the effect the financial responsibility determination has on the
characterization of the decision. Additionally, the chapter provides
general writing guidelines and the protocols for protecting personally
identifiable and protected health information in a decision. The
chapter also describes the format for a decision affirming the
dismissal of a request for reconsideration, a decision addressing
multiple consolidated appeals, and a stipulated decision. An OMHA-
approved notice of decision template must accompany every decision and
describes the parties' appeals rights. OMHA also issued a Citation
Policy as chapter support material to Chapter 16.
OCPM Chapter 15: Conducting Conferences and Hearings: Posthearing
Development
On November 21, 2019, OMHA issued OCPM Chapter 15, which describes
the process used by OMHA adjudicators when conducting prehearing/
[[Page 39573]]
posthearing conferences and hearings. The chapter details regulatory
requirements, OMHA administrative requirements, and suggested best
practices when conducting a conference or hearing. The chapter also
explains when and how to hold a consolidated, supplemental, or
continued hearing; the procedures for responding to a request for a
copy of the administrative record; and available actions that can be
taken to develop the administrative record after an initial hearing has
been conducted.
OCPM Chapter 10: Party and Non-Party Participant Requests and
Submissions
On February 19, 2020, OMHA issued OCPM Chapter 10, which explains
how to route, document and address contacts from parties and non-party
participants involving both general and case-specific matters. The
chapter describes how to provide language or communication assistance
services to individuals with limited English proficiency or a
disability, and summarizes the services OMHA offers in response to such
requests. The chapter also explains how to process requests for a stay
of proceedings, discovery, or subpoena; and review submissions of
evidence and other case-related materials. Many types of requests and
submissions that generally occur at a specific stage in the
adjudication process are covered in detail in other OCPM chapters. To
facilitate locating this information, Chapter 10 contains a list of
these requests and submissions, along with cross-references to the
specific OCPM provisions where they are discussed.
Dated: June 26, 2020.
Karen W. Ames,
Executive Director, Office of Medicare Hearings and Appeals.
[FR Doc. 2020-14203 Filed 6-30-20; 8:45 am]
BILLING CODE 4150-46-P
