Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim and Entitlement Appeals; Quarterly Listing of Program Issuances-October Through December 2022, 20172-20173 [2023-06995]
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20172
Federal Register / Vol. 88, No. 65 / Wednesday, April 5, 2023 / Notices
TOTAL ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents
Form name
Total
responses
Average
burden per
response
(in hours)
Total burden
hours
NHSC and Nurse Corps Interest Capture Form .................
16,144
1
16,144
.025
404
Total ..............................................................................
16,144
........................
16,144
........................
404
Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2023–07045 Filed 4–4–23; 8:45 am]
BILLING CODE 4165–15–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
[OMHA–2301–N]
Medicare Program; Administrative Law
Judge Hearing Program for Medicare
Claim and Entitlement Appeals;
Quarterly Listing of Program
Issuances—October Through
December 2022
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 2022. 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
lotter on DSK11XQN23PROD with NOTICES1
Number of
responses per
respondent
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
VerDate Sep<11>2014
17:44 Apr 04, 2023
Jkt 259001
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
PO 00000
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Fmt 4703
Sfmt 4703
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 2022. 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.
E:\FR\FM\05APN1.SGM
05APN1
Federal Register / Vol. 88, No. 65 / Wednesday, April 5, 2023 / Notices
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 2022
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 new OCPM provisions and the
subject matter. This information is
available on our website at https://
www.hhs.gov/about/agencies/omha/theappeals-process/case-processingmanual/.
OCPM Chapter 12: Administrative
Record and Exhibiting
On October 28, 2022, OMHA issued
OCPM Chapter 12, which provides
guidance on processing and developing
the administrative record for OMHA
appeals. OMHA is responsible for
creating and organizing a complete
record of the evidence and
administrative proceedings of the
appealed matter. This new chapter
explains how OMHA obtains the case
file from the prior adjudicating entity, as
well as how OMHA organizes and
exhibits records, creates an index of the
administrative record, and processes
new evidence. The chapter also details
how to document electronic and oral
communications, ensure the record is
complete, and address other recordrelated issues that could arise during the
appeal process.
Karen Ames,
Executive Director of Operations, Office of
Medicare Hearings and Appeals.
[FR Doc. 2023–06995 Filed 4–4–23; 8:45 am]
BILLING CODE 4150–46–P
lotter on DSK11XQN23PROD with NOTICES1
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Request for Nominations to the
Advisory Council on Alzheimer’s
Research, Care, and Services
Office of the Assistant
Secretary for Planning and Evaluation,
Department of Health and Human
Services.
ACTION: Notice.
AGENCY:
VerDate Sep<11>2014
17:44 Apr 04, 2023
The Secretary of HHS
established the Advisory Council on
Alzheimer’s Research, Care, and
Services to provide advice and
consultation to the Secretary on how to
prevent or reduce the burden of
Alzheimer’s disease and related
dementias on people with the disease
and their caregivers. The Secretary
signed the charter establishing the
Advisory Council on May 23, 2011.
HHS is soliciting nominations for six (6)
new non-federal members of the
Advisory Council to replace the six (6)
members whose terms will end
September 30, 2023. Nominations
should include, at a minimum, the
nominee’s contact information (current
mailing address, email address, and
telephone number) and current
curriculum vitae or resume.
DATES: Submit nominations by email or
USPS mail before COB on April 28,
2023.
SUMMARY:
Jkt 259001
Nominations should be sent
by email to: Helen Lamont, Ph.D., HHS
Office of the Assistant Secretary for
Planning and Evaluation, Room 424E,
Humphrey Building, 200 Independence
Avenue SW, Washington, DC 20201,
helen.lamont@hhs.gov and napa@
hhs.gov.
ADDRESSES:
FOR FURTHER INFORMATION CONTACT:
Helen Lamont (202) 260–6075,
helen.lamont@hhs.gov.
SUPPLEMENTARY INFORMATION: The
Advisory Council on Alzheimer’s
Research, Care, and Services meets
quarterly to discuss programs that
impact people with Alzheimer’s disease
and related dementias and their
caregivers. The Advisory Council makes
recommendations to Congress and the
Secretary of Health and Human Services
about ways to reduce the financial
impact of Alzheimer’s disease and
related dementias and to improve the
health outcomes of people with these
conditions. The Advisory Council also
provides feedback on a National Plan to
Address Alzheimer’s disease. On an
annual basis, the Advisory Council
evaluates the implementation of the
recommendations through an updated
National Plan. The National Alzheimer’s
Project Act, Public Law 111–375 (42
U.S.C. 11225), requires that the
Secretary of Health and Human Services
(HHS) establish the Advisory Council
on Alzheimer’s Research, Care, and
Services. The Advisory Council is
governed by provisions of Public Law
92–463 (5 U.S.C. Appendix 2), which
sets forth standards for the formation
and use of advisory committees.
The Advisory Council consists of 22
members. Ten members are designees
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Fmt 4703
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20173
from Federal agencies including the
Centers for Disease Control and
Prevention, Administration for
Community Living, Centers for
Medicare & Medicaid Services, Indian
Health Service, National Institutes of
Health, National Science Foundation,
Food and Drug Administration, Agency
for Healthcare Research and Quality,
Health Resources and Services
Administration, and Department of
Veterans Affairs. The Advisory Council
also consists of 12 non-federal members
selected by the Secretary who represent
6 categories of people impacted by
dementia: dementia caregivers (2),
health care providers (2),
representatives of State or local health
departments (2), researchers with
dementia-related expertise in basic,
translational, clinical, or drug
development science (2), voluntary
health association representatives (2),
and dementia patient advocates (2),
including one advocate who is currently
living with dementia.
At this time, the Secretary of HHS is
seeking nominations for new members
for each category (caregiver, health care
provider, state representative,
researcher, association representative,
dementia patient advocate currently
living with Alzheimer’s disease or a
related dementia), to replace the
members whose terms will end on
September 30, 2023, for a total of six (6)
new members to the Advisory Council.
After receiving nominations, the
Secretary, with input from his staff, will
make the final decision, and the new
members will be announced soon after.
Members shall be invited to serve until
the Advisory Council sunsets on
December 31, 2025 or a 4-year term if
the National Alzheimer’s Project Act is
reauthorized. Members will serve as
Special Government Employees.
Dated: March 20, 2023.
Miranda Lynch-Smith,
Senior Official Performing the Duties of the
Assistant Secretary for Planning and
Evaluation.
[FR Doc. 2023–07007 Filed 4–4–23; 8:45 am]
BILLING CODE 4150–05–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Solicitation of Nominations for
Appointment to the Advisory
Committee on Blood and Tissue Safety
and Availability (ACBTSA)
Office of the Assistant
Secretary for Health, Office of the
Secretary, U.S. Department of Health
and Human Services.
AGENCY:
E:\FR\FM\05APN1.SGM
05APN1
]]>Agencies
[Federal Register Volume 88, Number 65 (Wednesday, April 5, 2023)]
[Notices]
[Pages 20172-20173]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-06995]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
[OMHA-2301-N]
Medicare Program; Administrative Law Judge Hearing Program for
Medicare Claim and Entitlement Appeals; Quarterly Listing of Program
Issuances--October Through December 2022
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
2022. 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 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 2022. 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.
[[Page 20173]]
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 2022
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 new OCPM provisions and
the subject matter. This information is available on our website at
https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/.
OCPM Chapter 12: Administrative Record and Exhibiting
On October 28, 2022, OMHA issued OCPM Chapter 12, which provides
guidance on processing and developing the administrative record for
OMHA appeals. OMHA is responsible for creating and organizing a
complete record of the evidence and administrative proceedings of the
appealed matter. This new chapter explains how OMHA obtains the case
file from the prior adjudicating entity, as well as how OMHA organizes
and exhibits records, creates an index of the administrative record,
and processes new evidence. The chapter also details how to document
electronic and oral communications, ensure the record is complete, and
address other record-related issues that could arise during the appeal
process.
Karen Ames,
Executive Director of Operations, Office of Medicare Hearings and
Appeals.
[FR Doc. 2023-06995 Filed 4-4-23; 8:45 am]
BILLING CODE 4150-46-P
