For people awaiting Medicare appeal decisions, a plan to rearrange administrative work is not yet a shorter wait. The HHS final rule published January 17, 2017 authorized attorney adjudicators to handle specified matters that did not require an administrative law judge’s hearing. HHS estimated that about 24,500 appeals annually could move through those routes, rather than reporting that this work had already been completed. [2016-32058]

The scale of the queue appears in two dated accounts. The July 2016 proposal reported more than 750,000 pending appeals at the Office of Medicare Hearings and Appeals on April 30, with capacity of 77,000 appeals annually. The final rule reported more than 650,000 pending on September 30 and approximately 92,000 annual capacity. Those counts concern appeals, not unique patients. [2016-32058][2016-15192]

The proposed redistribution covered particular tasks: decisions available without a hearing, dismissals after an appellant withdrew a hearing request, specified remands and reviews of dismissals. It was not permission to bypass hearings across the board. That boundary matters to appellants because a faster administrative route and an opportunity to present a contested case answer different needs. [2016-32058]

HHS scheduled March 20, 2017 effectiveness. Neither earlier backlog snapshot can demonstrate an effect of that future rule. The practical public-interest test would be whether the reassignment improves processing while respecting the applicable hearing protections. The proposal and final rule supply the rationale and design within one agency process, not independent evidence that waiting has ended. [2016-32058][2016-15192]

Source documents

  1. Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedureshttps://www.govinfo.gov/content/pkg/FR-2017-01-17/html/2016-32058.htm
  2. Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedureshttps://www.govinfo.gov/content/pkg/FR-2016-07-05/html/2016-15192.htm