New Medicare Policy Will Limit Beneficiaries’ Access to Appeals Hearings
A new federal policy scheduled to take effect in July will "make it significantly more difficult" for Medicare beneficiaries to appeal claim denials in person before an administrative law judge, the New York Times reports. The 2003 Medicare law will shift the responsibility for such appeals from the Social Security Administration to HHS. In the past, judges have held hearings on Medicare appeals at more than 140 SSA offices nationwide, but under the new policy HHS plans to place judges in only four locations -- Cleveland; Miami; Irvine, Calif.; and Arlington, Va. In addition, judges will hold most hearings on Medicare appeals with videoconference equipment or by telephone, CMS officials said.
The videoconference equipment will allow Medicare beneficiaries, judges and witnesses in different parts of the nation to communicate over secure networks. HHS will encrypt video signals to ensure the privacy of medical information. Medicare beneficiaries will have the ability to send and receive documents related to the hearings by fax machine. According to the Times, HHS officials are "still working out details," which include the installation of videoconference links and the hiring of 50 additional judges.
Under the new policy, Medicare beneficiaries who request to appear in person before a judge must prove that "special or extraordinary circumstances exist," and beneficiaries who make such requests will lose the right to receive a decision within 90 days. The new policy also requires judges to adhere to the Medicare law and regulations and "give substantial deference" to manuals and guidelines issued by CMS officials. The new policy comes as Bush administration officials are "predicting an increase in the volume of cases," with the new Medicare prescription drug benefit expected to prompt a larger number of appeals, the Times reports.
Senate Finance Committee Chair Chuck Grassley (R-Iowa) and ranking member Sen. Max Baucus (D-Mont.) -- who were among the principal authors of the 2003 Medicare law -- have raised concerns about the number of locations for hearings on Medicare appeals under the new policy. They said that the law requires distribution of judges "throughout the United States."
Center for Medicare Advocacy Director Judith Stein said, "The videoconferences are one of many changes that will reduce the beneficiaries' ability to get fair, favorable decisions. Sick, old and disabled people can be much more effective in person because the judge can see their illnesses and infirmities -- how they walk, how they get up from a chair, how their hands shake with tremors." She added that under the new policy "it will be easier for Medicare officials to participate in hearings and to influence decisions, often to the detriment of beneficiaries."
Ronald Bernoski, president of the Association of Administrative Law Judges, said, "Video teleconferences will undermine the judges' ability to assess the credibility and demeanor of witnesses. And it could reduce the beneficiaries' confidence in the proceedings. The intrinsic value of a Medicare hearing is that citizens have an opportunity to sit down in front of a high-ranking official and tell their story to someone who listens carefully and makes a reasoned decision."
Nancy Thompson, HHS director of transition, declined to comment on the new policy. HHS officials have said that videoconference equipment could allow judges to "complete more cases" within the 90-day deadline, as they would not have to travel to remote locations. HHS also said that the placement of judges across the nation was "not economically or administratively feasible."
In a letter to Congress, HHS said, "Having fewer offices is more cost-effective in terms of management, technology and training." HHS Secretary Mike Leavitt said, "Access to hearings for Medicare beneficiaries will be as good as or better than" access under the current policy, adding, "Video teleconferences will allow hearings to be provided more timely, with vastly more access points than Social Security currently provides through its offices" (Pear, New York Times, 4/24).
In related news, the Boston Globe on Monday examined concerns from advocates for Medicare beneficiaries that the new prescription drug benefit will disrupt care for some beneficiaries. According to advocates, new Medicare prescription drug plans might not cover certain medications currently taken by some beneficiaries. The plans must cover medications for every condition, but "they are expected to narrow the choice of medicines to cut costs," according to the Globe. Advocates maintain that the plans could endanger nursing home residents with mental disabilities who cannot "advocate for themselves" and Medicare beneficiaries who take multiple medications "and are particularly vulnerable to side effects," the Globe reports. CMS Deputy Administrator Leslie Norwalk said, "We're trying to get nursing home residents competitive prices. But we don't want to turn everything upside down. We may have a bump or two along the road, but we are trying to anticipate the problems" (Dembner, Boston Globe, 4/25).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.