From MHPCA: Court Rules on ALJ Backlog- Win for Hospice and other providers
Jane Moore
Court Rules on ALJ Backlog for all Medicare Providers and Suppliers, Including Hospices
December 7, 2016
In the long-running litigation regarding the multi-year delays in obtaining an ALJ decision in a Medicare claim appeal, the U.S. District Court for the District of Columbia has ordered the government to meet specific targets in resolving the claims appeals over the next four years and to eliminate the backlog of cases pending at the ALJ level by the end of 2020. This is a win for all Medicare providers and suppliers, including hospices, that have appeals pending or are deciding whether to appeal to the ALJ level.
The lawsuit, which was filed by the American Hospital Association (AHA) in May 2014, sought to force the Department of Health and Human Services (HHS) to meet the 90-day statutory timeframe for a decision on a Medicare claim appeal at the ALJ level. Following an appeal to the D.C. Circuit by the AHA, the appeals court sent the case back to the District Court with instructions to consider ordering HHS to meet the statutory deadline. Back in the District Court, the government argued, among other things, that it had implemented administrative processes that had made in-roads in resolving the logjam of appeals. The Court, however, was not convinced that sufficient progress was being made.
The AHA had proposed specific steps the government could take to address the backlog of appeals but also offered, as an alternative, a specific timetable by which the Secretary must achieve reductions. The Court, stating that it wanted to “intrude as little as possible on the Secretary’s specific decision making processes and operations,” opted for the timetable. As proposed by the AHA, and ordered by the Court, the government must achieve a 30 percent reduction in the current backlog of cases pending at the ALJ level by December 31, 2017; a 60 percent reduction by December 31, 2018; a 90 percent reduction by December 31, 2019; and elimination of the backlog by the end of 2020. The government must provide the Court with reports every 90 days, describing HHS’s progress and providing updated figures on the current and projected backlog.
Read the Court’s opinion here.
Jane Moore
CEO
Missouri Hospice & Palliative Care Assn.
600 Monroe Street
Suite 300
Jefferson City, MO 65101
Phone 573-634-5514
Fax 573-635-0659
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