Medicare Rights Comments to Protect Appeal Rights

This week, Medicare Rights responded to proposals from the Centers for Medicare & Medicaid Services (CMS) that would make changes to the Medicare appeals process. Medicare Rights was supportive of some proposals to streamline and modernize the appeals process, and expressed concern about others that may undermine important beneficiary rights and protections.

For example, Medicare Rights objected to a proposal that would give one member of the Medicare Appeals Council (the Council) complete authority to designate certain decisions of the Council to have precedential authority – meaning the decision would have to be followed in all subsequent appeals.

Because beneficiaries are not always represented in their appeals, the Council’s decision might not be based the most complete legal arguments, and there is nothing in the proposed rule to guide decision making about which Council decisions should be given this authority.

Medicare Rights is generally supportive of, though encourages limitations on, a proposal to allow “Attorney Adjudicators” to make some decisions that do not require the time and attention of an Administrative Law Judge (ALJ). These trained lawyers would be able to handle dismissals where one party to the appeal withdraws their request for the appeal, for example, and would free up the ALJ to focus on the contested cases before them.

Medicare Rights is also supportive of several proposed wording changes to confirm and affirm that beneficiaries have a right to a hearing, not just that they may request one, to increase the specificity of named entities to reduce confusion, and to provide more examples about how to calculate important requirements, like the timeframe for responses and the dollar amount that must be in dispute for an ALJ to hear an appeal, otherwise known as the amount in controversy.

Read Medicare Rights’ comments.