Medicare Compliance & Reimbursement
HHAs WANT CMS TO KEEP HANDS OFF ALJs
The Centers for Medicare & Medicaid Services’ campaign to reform the appeals process isn’t convincing everyone. Advocates for home health agencies are sharply critical of proposed changes.
The House Ways and Means Health Subcommittee held a hearing on the matter Feb. 13, hosted by chair Nancy Johnson (R-CT) and ranking minority member Pete Stark (D-CA). At the hearing, CMS Administrator Tom Scully emphasized CMS’ determination to get the administrative law judges under its wing. “We are proceeding toward the transfer to CMS of the Medicare hearing function currently performed by the Administrative Law Judges (ALJ) in the Social Security Administration (SSA),” Scully said in prepared comments for the hearing. “We have already had extensive discussions with SSA to explore administratively transferring the Medicare hearing function to CMS.”
Scully also pushed for looser appeals deadlines than were legislated in the Benefits Improvement and Protection Act of 2000. He called for deadlines to remain at 45 days for Part B contractors and 90 days for Part A reconsiderations. He also pushed for an extension to 180 days for ALJs and the Departmental Appeals Board.
But “it is crucial that the appeals process operate within reasonable and structured time deadlines,” Wolf said in prepared comments. “Current delays may often mean the appeals process survives longer than the patient or provider.” Scully praised CMS for streamlining the OASIS tool and holding Open Door Forum meetings. He also announced CMS’ intention to move from its current 46 Medicare contractors to “20 to 25 who are in it for the long haul.”
Wolf entreated Congress to pass a number of helpful reform points, including a prohibition on retroactive application of measures, a chance to comment on substantive changes and a safe harbor for providers following written guidance from a Medicare contractor.
But home care providers just as surely oppose the move. “The independence of the administrative law judges that preside over fair hearings should be preserved,” insisted Janet Wolf, president of Traverse City, MI-based Munson Home Health and a representative of the National Association for Home Care & Hospice.
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