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]
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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:
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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
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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.)
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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
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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
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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
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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
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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
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SUMMARY:
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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
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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.
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]]>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]
-----------------------------------------------------------------------
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]
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