HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Sunday, April 24, 2005

New Medicare Policy - Fewer In-Person Appeals

The New York Times reports today on the Bush Administration's new policy for Medicare beneficiaries who wish to "obtain hearings in person before a judge when the government denies their claims for home care, nursing home services, prescription drugs and other treatments."  The future for Medicare appeals does not sound promising:

For years, hearings have been held at more than 140 Social Security offices around the country. In July, the Department of Health and Human Services will take over the responsibility, and department officials said all judges would then be located at just four sites - in Cleveland; Miami; Irvine, Calif.; and Arlington, Va.

Under the new policy, Medicare officials said, most hearings will be held with videoconference equipment or by telephone. A beneficiary who wants to appear in person before a judge must show that "special or extraordinary circumstances exist," the rules say. But a beneficiary who insists on a face-to-face hearing will lose the right to receive a decision within 90 days, the deadline set by statute.

The policy change comes as Bush administration officials are predicting an increase in the volume of cases, with the creation of a Medicare drug benefit expected to generate large numbers of claims and appeals. But in a recent study, the Government Accountability Office, an investigative arm of Congress, questioned the heavy reliance on videoconferences, saying that "beneficiaries are often uncomfortable using videoconference facilities and prefer to have their cases heard face to face."

I don't see how four hearing offices will be sufficient but perhaps I am being overly pessimistic.  I had not realized that Medicare drug benefit, in addition to being wildly expensive, would also have this type of side effect on the Medicare program.[bm]

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