February 2017
HHS Finalizes Appeals Backlog Rule in Wake of Judicial Order

The U.S. Department of Health and Human Services (HHS) released a Final Rule aimed at reducing and eventually eliminating the backlog of more than 650,000 claims currently awaiting adjudication by an administrative law judge (ALJ) at the Office of Medicare Hearings and Appeals (OMHA). The Final Rule, published January 17 and titled “Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures,” comes in the wake of U.S. District Court Judge James Boasberg’s order to HHS requiring it to reduce the backlog of cases pending before ALJs by 30 percent by the end of 2017, by 60 percent by the end of 2018, by 90 percent by the end of 2019, and completely by the end of 2020.

Unfortunately, by HHS’s own admission, the initiatives contained in the Final Rule alone will not eliminate the appeals backlog in accordance with the timeline dictated by Judge Boasberg. And, as a further blow to HHS’s plans, the Trump Administration issued memorandum freezing new and pending regulations until such a time as newly installed agency heads can review them; this could potentially delay the implementation of the Final Rule, currently scheduled for March 20, 2017, or possibly kill it altogether, pending such review.

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