Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim and Entitlement Appeals; Quarterly Listing of Program Issuances-October Through December 2021, 17093-17095 [2022-06326]

Download as PDF Federal Register / Vol. 87, No. 58 / Friday, March 25, 2022 / Notices To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following: 1. Access CMS’ website address at website address at https://www.cms.gov/ Regulations-and-Guidance/Legislation/ PaperworkReductionActof1995/PRAListing. FOR FURTHER INFORMATION CONTACT: William N. Parham at (410) 786–4669. SUPPLEMENTARY INFORMATION: lotter on DSK11XQN23PROD with NOTICES1 Contents This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection’s supporting statement and associated materials (see ADDRESSES). CMS–10507 State-based Exchange Annual Report Tool (SMART) CMS–10105 National Implementation of the In-Center Hemodialysis CAHPS Survey Under the PRA (44 U.S.C. 3501– 3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term ‘‘collection of information’’ is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice. Information Collection 1. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: State-based Exchange Annual Report Tool (SMART); Use: The annual report is the primary vehicle to insure comprehensive compliance with all reporting requirements contained in the Affordable Care Act (ACA). It is specifically called for in Section 1313(a)(1) of the Act which requires a State Based Exchange (including an Exchange using the Federal Platform) to keep an accurate accounting of all activities, receipts, and expenditures, and to submit a report annually to the VerDate Sep<11>2014 16:50 Mar 24, 2022 Jkt 256001 Secretary concerning such accounting. CMS will use the information collected from States to assist in determining if a State is maintaining a compliant operational Exchange. Form Number: CMS–10507 (OMB control number: 0938–1244); Frequency: Annually; Affected Public: State, Local, or Tribal governments; Number of Respondents: 21; Total Annual Responses: 21; Total Annual Hours: 4,281. (For policy questions regarding this collection contact Shilpa Gogna at 301–492–4257.) 2. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: National Implementation of the In-Center Hemodialysis CAHPS Survey; Use: The national implementation of the ICH CAHPS Survey is designed to allow third-party, CMS-approved survey vendors to administer the ICH CAHPS Survey using mail-only, telephone-only, or mixed (mail with telephone followup) modes of survey administration. Experience from previous CAHPS surveys shows that mail, telephone, and mail with telephone follow-up data collection modes work well for respondents, vendors, and health care providers. Any additional forms of information technology, such as web surveys, is under investigation as a potential survey option in this population. Data collected in the national implementation of the ICH CAHPS Survey are used for the following purposes: • To provide a source of information from which selected measures can be publicly reported to beneficiaries as a decision aid for dialysis facility selection. • To aid facilities with their internal quality improvement efforts and external benchmarking with other facilities. • To provide CMS with information for monitoring and public reporting purposes. • To support the ESRD Quality Improvement Program. Form Number: CMS–10105 (OMB control number: 0938–0926); Frequency: Semi Annually; Affected Public: Individuals and Households; Number of Respondents: 103,500; Total Annual Responses: 621,000; Total Annual Hours: 55,890. (For policy questions regarding this collection contact Israel H. Cross at 410–786–0619.) PO 00000 Frm 00031 Fmt 4703 Sfmt 4703 17093 Dated: March 22, 2022. William N. Parham, III, Director, Paperwork Reduction Staff, Office of Strategic Operations and Regulatory Affairs. [FR Doc. 2022–06341 Filed 3–24–22; 8:45 am] BILLING CODE 4120–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES [OMHA–2201–N] Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim and Entitlement Appeals; Quarterly Listing of Program Issuances—October Through December 2021 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 October through December 2021. 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: Jon Dorman, by telephone at (571) 457– 7220, or by email at jon.dorman@ 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 E:\FR\FM\25MRN1.SGM 25MRN1 lotter on DSK11XQN23PROD with NOTICES1 17094 Federal Register / Vol. 87, No. 58 / Friday, March 25, 2022 / Notices 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 VerDate Sep<11>2014 16:50 Mar 24, 2022 Jkt 256001 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 October through December 2021. 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 October Through December 2021 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 October through December 2021. This information is available on our website at https://www.hhs.gov/about/agencies/ omha/the-appeals-process/caseprocessing-manual/. General OCPM Updates The Code of Federal Regulations (CFR) is the codification of the general and permanent rules published in the Federal Register by the executive PO 00000 Frm 00032 Fmt 4703 Sfmt 4703 departments and agencies of the Federal Government. The OCPM frequently cites to the governing regulations for the Medicare Program contained in the CFR. The OCPM provides hyperlinks to those regulation citations at the Electronic Code of Federal Regulations (eCFR) website, available at https:// www.ecfr.gov. In late summer 2021, the eCFR website underwent significant updates. These updates rendered many of the eCFR hyperlinks embedded in the OCPM inoperable. To reconcile the OCPM with these updates, OMHA made revisions to footnotes and citations in the following sections: 4.4.1.3, 5.2.1.2, 5.4.1, 5.4.3, 7.1.1.1, 7.1.1.2, 7.1.4.1, 7.2.1, 7.2.2, 7.3.1, 7.3.2, 7.3.4, 7.4.3, 7.5.2, 7.5.4, 7.5.5, 7.5.6, 7.5.8, 7.5.9, 10.5.2, 10.5.3, 10.7.10.1, 10.7.11, 10.7.11.1, 10.7.11.2, 11.3.2, 11.4.5, 17.1.4, 17.1.5.2, 17.1.5.4, 17.1.11.1, 17.2.1, 20.1.4, 20.2.2, 20.4.3. OCPM Chapter 11: Procedural Review and Determinations—Section 11.3.2 This chapter was initially released on May 24, 2019, and was included in a quarterly notice published in the July 16, 2019 Federal Register (84 FR 33956). Section 11.3 of this chapter describes the amount in controversy (AIC) that is the statutory threshold monetary amount that a party with standing to appeal must meet to be entitled to a hearing or review of a dismissal. CMS issues annual adjustments to the AIC threshold amounts for ALJ hearings and judicial review under the Medicare appeals process. This revision to OCPM 11.3.2 updates the table in this section to reflect the AIC for the ten most recent calendar years. OCPM Chapter 16: Decisions—Section 16.4.3 This chapter was initially released on October 9, 2019, and was included in a quarterly notice published in the July 1, 2020 Federal Register (85 FR 39571). Section 16.4.3 of this chapter describes when an adjudicator issues a stipulated decision. A stipulated decision may be issued when CMS, a CMS contractor, or a plan submits a written statement, or makes an oral statement at a hearing, indicating that an enrollee’s at-risk determination should be reversed, or that the items or services at issue should be covered or payment may be made, and agreeing to the amount of payment that the parties believe should be made, if the amount of payment is at issue. This revision updates footnote 15 in section 16.4.3 to reflect the revised regulation at 42 CFR 422.562(d)(3) that became effective on March 22, 2021 (86 E:\FR\FM\25MRN1.SGM 25MRN1 Federal Register / Vol. 87, No. 58 / Friday, March 25, 2022 / Notices FR 6101), which provides that, ‘‘for the sole purpose of applying the regulations at § 405.1038(c) of this chapter, an MA organization is included in the definition of ‘‘contractors’’ as it relates to stipulated decisions.’’ OCPM Chapter 20: Post-Adjudication Actions—Sections 20.5.3, 20.6.4, 20.7.4, 20.8.4, 20.9.2, 20.11.2 This chapter was initially released on May 25, 2018, and was included in a quarterly notice published in the August 7, 2018 Federal Register (83 FR 38700). Since the initial release, the OMHA Central Operations office relocated. This revision updates the Central Operations mailing address accordingly in sections 20.5.3, 20.6.4, 20.7.4, 20.8.4, 20.9.2, and 20.11.2. Karen W. Ames, Executive Director, Office of Medicare Hearings and Appeals. [FR Doc. 2022–06326 Filed 3–24–22; 8:45 am] BILLING CODE 4150–46–P DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Proposed Collection; 60-Day Comment Request; Hazardous Waste Worker Training—National Institute of Environmental Health Sciences (NIEHS) AGENCY: National Institutes of Health, HHS. ACTION: Notice. In compliance with the requirement of the Paperwork Reduction Act of 1995 to provide opportunity for public comment on proposed data collection projects, the National Institute of Environmental Health Sciences (NIEHS) will publish periodic summaries of proposed projects to be submitted to the Office of Management and Budget (OMB) for review and approval. DATES: Comments regarding this information collection are best assured of having their full effect if received within 60 days of the date of this publication. FOR FURTHER INFORMATION CONTACT: To obtain a copy of the data collection plans and instruments, submit comments in writing, or request more information on the proposed project, contact: Sharon D. Beard, Director, Worker Training Program (WTP), Division of Extramural Research and Training (DERT), NIEHS, P.O. Box 12233 MD: K3–14, Research Triangle Park, NC 27709 or call non-toll-free lotter on DSK11XQN23PROD with NOTICES1 SUMMARY: VerDate Sep<11>2014 16:50 Mar 24, 2022 Jkt 256001 number 984–287–3237 or Email your request, including your address to: beard1@niehs.nih.gov. Formal requests for additional plans and instruments must be requested in writing. SUPPLEMENTARY INFORMATION: Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires: Written comments and/or suggestions from the public and affected agencies are invited to address one or more of the following points: (1) Whether the proposed collection of information is necessary for the proper performance of the function 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) Ways to enhance the quality, utility, and clarity of the information to be collected; and (4) Ways to minimizes the burden of the collection of information on those who are to respond, including the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology. Proposed Collection Title: Hazardous Waste Worker Training Grantee Data Collection—42 CFR part 65, 0925–0348, Expiration Date 07/31/2022 REVISION, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH). Need and Use of Information Collection: The National Institute of Environmental Health Sciences (NIEHS) was given major responsibility for initiating a worker safety and health training program under section 126 of the Superfund Amendments and Reauthorization Act of 1986 (SARA) for hazardous waste workers and emergency responders. A network of non-profit organizations that are committed to protecting workers and their communities by delivering highquality, peer-reviewed safety and health curricula to target populations of hazardous waste workers and emergency responders has been developed. The NIEHS Worker Training Program (WTP) contains the Hazardous Waste Worker Training Program (HWWTP) and the NIEHS/Department of Energy (DOE) Nuclear Worker Training Program to fund nonprofit organizations to develop and administer model health and safety training programs for hazardous materials or waste workers. The HWWTP provides occupational safety and health training for workers who may be engaged in activities related to hazardous waste PO 00000 Frm 00033 Fmt 4703 Sfmt 4703 17095 removal, containment, or chemical emergency response. This program is the core component of WTP. The other optional programs include the Environmental Career Worker Training Program (ECWTP) that focuses on delivering comprehensive training to increase the number of disadvantaged and underrepresented workers in areas such as environmental restoration, construction, hazardous materials/waste handling, and emergency response and the HAZMAT Disaster Preparedness Training Program (HDPTP) that supports the development and delivery of training for hazardous material and debris cleanup commonly needed after natural and man-made disasters. The purpose of the NIEHS/DOE Nuclear Worker Training Program is to support the development of model programs for the training and education of workers engaged in activities related to hazardous materials and waste generation, removal, containment, transportation and emergency response within the DOE nuclear weapons complex. In thirty-five years (FY 1987– 2022) the WTP has successfully supported 25 primary grantees that have trained more than 4.5 million workers across the country and presented over 278,821 classroom, hands-on, and online training courses, which have accounted for over 55 million contact hours of actual training. Generally, the grant will initially be for one year, and subsequent continuation awards are also for one year at a time. Grantees must submit a separate application to have the support continued for each subsequent year. Grantees are to provide information in accordance with S65.4 (a), (b), (c) and 65.6(a) on the nature, duration, and purpose of the training, selection criteria for trainees’ qualifications and competency of the project director and staff, the adequacy of training plans and resources, including budget and curriculum, and response to meeting training criteria in OSHA’s Hazardous Waste Operations and Emergency Response Regulations (29 CFR 1910.120). As a cooperative agreement, there are additional requirements for the progress report section of the application. Grantees are to provide their information into the WTP Grantee Data Management System. The information collected is used by the Director through officers, employees, experts, and consultants to evaluate applications based on technical merit to determine whether to make awards and whether appropriate training is being conducted to support continuation of the grant into subsequent years. E:\FR\FM\25MRN1.SGM 25MRN1

Agencies

[Federal Register Volume 87, Number 58 (Friday, March 25, 2022)]
[Notices]
[Pages 17093-17095]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-06326]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

[OMHA-2201-N]


Medicare Program; Administrative Law Judge Hearing Program for 
Medicare Claim and Entitlement Appeals; Quarterly Listing of Program 
Issuances--October Through December 2021

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 October through December 
2021. 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: 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

[[Page 17094]]

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 October through 
December 2021. 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 October Through December 2021

    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 October through 
December 2021. This information is available on our website at https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/.

General OCPM Updates

    The Code of Federal Regulations (CFR) is the codification of the 
general and permanent rules published in the Federal Register by the 
executive departments and agencies of the Federal Government. The OCPM 
frequently cites to the governing regulations for the Medicare Program 
contained in the CFR. The OCPM provides hyperlinks to those regulation 
citations at the Electronic Code of Federal Regulations (eCFR) website, 
available at https://www.ecfr.gov.
    In late summer 2021, the eCFR website underwent significant 
updates. These updates rendered many of the eCFR hyperlinks embedded in 
the OCPM inoperable. To reconcile the OCPM with these updates, OMHA 
made revisions to footnotes and citations in the following sections: 
4.4.1.3, 5.2.1.2, 5.4.1, 5.4.3, 7.1.1.1, 7.1.1.2, 7.1.4.1, 7.2.1, 
7.2.2, 7.3.1, 7.3.2, 7.3.4, 7.4.3, 7.5.2, 7.5.4, 7.5.5, 7.5.6, 7.5.8, 
7.5.9, 10.5.2, 10.5.3, 10.7.10.1, 10.7.11, 10.7.11.1, 10.7.11.2, 
11.3.2, 11.4.5, 17.1.4, 17.1.5.2, 17.1.5.4, 17.1.11.1, 17.2.1, 20.1.4, 
20.2.2, 20.4.3.

OCPM Chapter 11: Procedural Review and Determinations--Section 11.3.2

    This chapter was initially released on May 24, 2019, and was 
included in a quarterly notice published in the July 16, 2019 Federal 
Register (84 FR 33956). Section 11.3 of this chapter describes the 
amount in controversy (AIC) that is the statutory threshold monetary 
amount that a party with standing to appeal must meet to be entitled to 
a hearing or review of a dismissal.
    CMS issues annual adjustments to the AIC threshold amounts for ALJ 
hearings and judicial review under the Medicare appeals process. This 
revision to OCPM 11.3.2 updates the table in this section to reflect 
the AIC for the ten most recent calendar years.

OCPM Chapter 16: Decisions--Section 16.4.3

    This chapter was initially released on October 9, 2019, and was 
included in a quarterly notice published in the July 1, 2020 Federal 
Register (85 FR 39571). Section 16.4.3 of this chapter describes when 
an adjudicator issues a stipulated decision. A stipulated decision may 
be issued when CMS, a CMS contractor, or a plan submits a written 
statement, or makes an oral statement at a hearing, indicating that an 
enrollee's at-risk determination should be reversed, or that the items 
or services at issue should be covered or payment may be made, and 
agreeing to the amount of payment that the parties believe should be 
made, if the amount of payment is at issue. This revision updates 
footnote 15 in section 16.4.3 to reflect the revised regulation at 42 
CFR 422.562(d)(3) that became effective on March 22, 2021 (86

[[Page 17095]]

FR 6101), which provides that, ``for the sole purpose of applying the 
regulations at Sec.  405.1038(c) of this chapter, an MA organization is 
included in the definition of ``contractors'' as it relates to 
stipulated decisions.''

OCPM Chapter 20: Post-Adjudication Actions--Sections 20.5.3, 20.6.4, 
20.7.4, 20.8.4, 20.9.2, 20.11.2

    This chapter was initially released on May 25, 2018, and was 
included in a quarterly notice published in the August 7, 2018 Federal 
Register (83 FR 38700). Since the initial release, the OMHA Central 
Operations office relocated. This revision updates the Central 
Operations mailing address accordingly in sections 20.5.3, 20.6.4, 
20.7.4, 20.8.4, 20.9.2, and 20.11.2.

Karen W. Ames,
Executive Director, Office of Medicare Hearings and Appeals.
[FR Doc. 2022-06326 Filed 3-24-22; 8:45 am]
BILLING CODE 4150-46-P