HHS proposes changes to Medicare appeals procedures

The Department of Health & Human Services today released a proposed rule that would make changes to the procedures for Administrative Law Judge appeals of payment and coverage determinations for items and services provided to Medicare beneficiaries, in addition to other Medicare appeals. Specifically, the proposed rule would allow attorney adjudicators to hear appeals in lieu of ALJs in some cases and allow the HHS Departmental Appeals Board to designate certain decisions as precedential. “We are skeptical that these proposals will do more than scratch the surface of the severe backlog in ALJ appeals that has led to hospitals facing multi-year waits for hearings,” said AHA Executive Vice President Tom Nickels. “We are deeply disappointed that HHS has not made more progress in addressing the delays despite the more than two years since the delays began. Further, we find the timing of today’s proposals interesting, given that it’s just days before HHS was required to respond in court to show progress in resolving the backlog as part of our lawsuit challenging the ALJ delays.” Comments on the proposed rule are due Aug. 29.