Providers' chances of getting a fair hearing may have just gotten slimmer.
A video conference soon may be the way you have to make your case before an ALJ.
Medicare hearings conducted by administrative law judges (ALJs) switched from the Social Security Administration to the Department of Health and Human Services July 1, HHS says. Providers and beneficiaries have long opposed the move, fearing that the ALJs' decision-making will be compromised by the Centers for Medicare & Medicaid Services' efforts to bring them in line with CMS policies and procedures (see Eli's HCW, Vol. XIII, No. 36).
HHS is forging ahead with its plan to switch many hearings to video conferences instead of in-person meetings, the agency says in a release. HHS expects to meet the 90-day ALJ decision timeframe mandated by the Benefits Improvement and Protection Act of 2000 "by using video teleconferencing technology (VTC) with a state-of-the-art electronic hearings process to provide significantly more access points than currently exist," the agency maintains. "HHS has access to VTC sites in over 1,000 cities nationwide."
Many parties, including prominent lawmakers, have voiced concerns about switching to video conferencing (see Eli's HCW, Vol. XIV, No. 22). HHS offers those detractors an olive branch in its latest release.
"Both VTC and in-person hearings will be offered as appropriate to best meet the needs of all parties," HHS maintains. "To the extent that an in-person hearing is required, that hearing will be granted in the location most convenient to the parties."
Further, ALJs "will travel to various locations around the country to conduct in-person hearings, as needed, which may include the use of local government facilities or other available sites," HHS promises. The adult day care demonstration that originally was scheduled to begin this month actually will start in February 2006, CMS says in a release.
Under the project, CMS will choose up to five home health agencies "to partner with medical adult day care facilities to provide medical adult day care services to Medicare beneficiaries as a substitute for a portion of home health services that would otherwise be provided in the home," the agency explains.
Up to 15,000 beneficiaries will be eligible to enroll in the three-year demo, CMS says. Informationon how to apply for the demo will be in a forthcoming Federal Register notice.
CMS has unveiled third-quarter prices for respiratory drugs. The latest fee schedule boosts the price for budesonide, lowers that for ipratropium and puts albuterol back at first-quarter levels.
CMS initially posted a fee schedule that contained the wrong price for albuterol compound solution but has since corrected that to $2.36. The fee schedule is at
www.cms.hhs.gov/providers/drugs/asp.asp.
CMS has changed its rules on "voided, canceled and deleted" claims in Transmittal 159 (Change Request 3627), [...]
