Claims Appeal Transfer Concerns Senators

Washington

Members of the Senate committee that oversees Medicare have raised concerns over plans to move the program’s claims appeals from the Social Security Administration to the Department of Health and Human Services.

Senate Finance Committee Chair-man Charles Grassley, R-Iowa, and Sen. Max Baucus, D-Mont., say that staffing may be an issue when the government transfers Administrative Law Judges — who handle Medicare claims appeals — to HHS. The Medicare Modernization Act mandates the move no later than Oct. 1.

While Social Security has about 950 judges and a support staff of about 5,200 working out of more than 100 offices nationwide, HHS plans to bring on only 50 judges working out of three field offices.

In a March 25 letter to HHS Secretary Michael Leavitt, the lawmakers wrote that having so few offices could limit beneficiary access to judges.

“While we understand the need to design the process with an eye on controlling costs, we feel that three offices do not rise to the level of a geographic distribution as envisioned by Congress in enacting the MMA,” they stated.

The senators also said they were concerned that HHS has yet to make new hires. “While we realize that there is a lengthy hiring process, especially for ALJs, we are concerned that no staff, including management, is on board yet. In fact, we understand that several of the position descriptions and vacancy announcements have not even been written.”

The transfer has raised concerns among providers as well. ALJs, who handle second-level appeals, have maintained impartiality because they work for Social Security, observers say, and moving them under the HHS umbrella could create a conflict of interest.

But HHS contends that other reform efforts should alleviate the problem. Medicare will soon be contracting out to new entities called Qualified Independent Contractors to handle first-level appeals. The QICs will reconsider all cases involving medical necessity issues. This, according to HHS, should drastically reduce the number of cases passed on to the ALJs.

For more on the transfer, visit HHS’ Medicare Hearings and Appeals Transition Web site, www.hhs.gov/asam/mhat.html.