How Trump plans to fix the Medicare appeals process

President Donald Trump included proposals to fix the Medicare appeals process in his fiscal year 2018 budget released Tuesday.

The budget calls for investing $1.3 billion over 10 years to address the backlog of Medicare appeals. In addition to the funding, the budget states that HHS is exploring ways to revamp the appeals process to ensure appeals are addressed as early as possible.

"These changes will make the appeals system easier to navigate, increase adjudicatory capacity to address incoming annual receipts and reduce backlogged appeals pending at the Office of Medicare Hearings and Appeals and the Departmental Appeals Board," states HHS' budget in brief. "The department is committed to work with Congress to address the Medicare appeals backlog."

Specific reforms to the Medicare appeals process outlined in President Trump's fiscal year 2018 HHS budget include remanding an appeal to the first level of the appeal process when new evidence is submitted, increasing the amount in controversy required for adjudication by an administrative law judge and allowing the Office of Medicare Hearings and Appeals to issue decisions without holding a hearing when neither side disputes the facts in the appeal.

Federal law requires OMHA to hear appeals within 90 days, but it currently takes OMHA about 1,000 days to adjudicate some appeals, according to the budget in brief.  

The American Hospital Association sued HHS over the Medicare appeals backlog in 2014, and a federal judge granted the AHA's motion for summary judgment in the case last year. The judge ordered HHS to incrementally reduce the backlog of appeals pending before OMHA over the next four years, reducing the backlog by 30 percent by the end of 2017; 60 percent by the end of 2018; 90 percent by the end of 2019; and to completely eliminate the backlog by Dec. 31, 2020.

In March, HHS said in a court filing that it will not be able to meet the deadlines imposed by the court for clearing the appeals backlog. HHS appealed the order to clear the backlog, and an appellate court recently heard oral arguments in the case.

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