Senators Raise Concerns Over New Policy on Medicare Appeals in Letter to HHS Secretary
Some Medicare beneficiaries might have "significant difficulty" with appeals of claim denials after the responsibility for such appeals shifts from the Social Security Administration to HHS, Senate Finance Committee Chair Chuck Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.) wrote in a recent letter to HHS Secretary Mike Leavitt and SSA Commissioner Jo Anne Barnhart, CQ HealthBeat reports (CQ HealthBeat, 4/25).
A provision in the 2003 Medicare law scheduled to take effect in July will shift the responsibility for Medicare appeals from SSA 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. HHS officials have not finalized the 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 (California Healthline, 4/25).
In the letter, Grassley and Baucus raised concerns about the limited number of locations for hearings on Medicare appeals under the new policy. They also wrote that HHS might not have the support systems and staff required under the new policy in place by the deadline of Oct. 1, 2005. "We understand that several of the position descriptions and vacancy announcements have not even been written," they wrote.
HHS spokesperson Bill Hall said, "The image some are conjuring up of grandma traveling 500 miles with a wheelchair and an oxygen tank isn't going to happen." According to Hall, the videoconference system that HHS will use for the Medicare appeals hearings is "now mainstream" and often used by SSA and the legal system. Hall also said that 90% of Medicare appeals are filed by health providers and law firms, not individual beneficiaries (CQ HealthBeat, 4/25).