FOR IMMEDIATE RELEASE, Contact: (202) 225-3943
April 12, 1999
No. HL-4
Congressman Bill Thomas (R-CA), Chairman, Subcommittee on Health of the Committee on Ways and Means, today announced that the Subcommittee will hold a hearing on how the Health Care Financing Administration (HCFA) makes decisions regarding Medicare covered services and what opportunities exist for seniors to appeal those decisions. The hearing will take place on Thursday, April 22, 1999, in the main committee hearing room, 1100 Longworth House Office Building, beginning at 1:00 p.m.
In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Committee and for inclusion in the printed record of the hearing.
BACKGROUND:
Coverage is an important concept in understanding Medicare benefits: the Social Security Act requires that all medical services be "reasonable and necessary" for the treatment of an illness or injury. HCFA and its private-sector contractors (known as fiscal intermediaries and carriers) have broad discretion to make Medicare coverage decisions. In some cases, the agency makes sweeping National Coverage Determinations (NCD). Under current law, beneficiaries can appeal many Medicare decisions but they are largely foreclosed from appealing NCDs.
The current Medicare appeals system can best be characterized as a patch-work - a large number of independent appeal processes addressing a multitude of diverse issues. Medicare appeals are divided into three distinct parts: Medicare Part A (generally hospital inpatient stays), Medicare Part B (generally physician services), and Medicare managed care. Each of these three parts is, in turn, broken into distinct sub-parts, one for beneficiaries seeking covered services and others for medical providers seeking reimbursement for services. HCFA uses a number of levels of review, including governmental contractors (fiscal intermediaries and carriers), review panels (Provider Reimbursement Review Board, Peer Review Organizations, Departmental Appeals Board) and judicial officers (Administrative Law Judges and Federal U.S. District Courts).
The current appeals processes stem from the Omnibus Budget Reconciliation Act of 1986 (OBRA86) in which Congress made several important reforms to the Medicare appeals system. Since then, the appeals process has become increasingly complex and time-consuming. An increase in the number and complexity of appeals calls into question the adequacy of the current system. Many Supreme Court and Federal court decisions concerning the Medicare appeals system have raised basic questions about its fundamental fairness to beneficiaries and providers.
In announcing the hearing, Chairman Thomas stated: "At a time when the Administration is seeking swifter appeals in private health plans, it is only fitting that we consider how various appeals are handled in governmental programs like Medicare. There are too many people, including Federal bureaucrats and governmental contractors, making coverage decisions without being held accountable. America's seniors deserve a meaningful opportunity to question these decisions."
FOCUS OF THE HEARING:
This hearing will analyze the processes available for seniors and medical providers to appeal payment and coverage determinations under Parts A and B of the Medicare program.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Any person or organization wishing to submit a written statement for the printed record of the hearing should submit six (6) single-spaced copies of their statement, along with an IBM compatible 3.5-inch diskette in WordPerfect 5.1 format, with their name, address, and hearing date noted on a label, by the close of business, Thursday, May 6, 1999, to A.L. Singleton, Chief of Staff, Committee on Ways and Means, U.S. House of Representatives, 1102 Longworth House Office Building, Washington, D.C. 20515. If those filing written statements wish to have their statements distributed to the press and interested public at the hearing, they may deliver 200 additional copies for this purpose to the Subcommittee on Health office, room 1136 Longworth House Office Building, by close of business the day before the hearing.
FORMATTING REQUIREMENTS:
Each statement presented for printing to the Committee by a witness, any written statement or exhibit submitted for the printed record or any written comments in response to a request for written comments must conform to the guidelines listed below. Any statement or exhibit not in compliance with these guidelines will not be printed, but will be maintained in the Committee files for review and use by the Committee.
1. All statements and any accompanying exhibits for printing must be submitted on an IBM compatible 3.5-inch diskette in WordPerfect 5.1 format, typed in single space and may not exceed a total of 10 pages including attachments. Witnesses are advised that the Committee will rely on electronic submissions for printing the official hearing record.
2. Copies of whole documents submitted as exhibit material will not be accepted for printing. Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material not meeting these specifications will be maintained in the Committee files for review and use by the Committee.
3. A witness appearing at a public hearing, or submitting a statement for the record of a public hearing, or submitting written comments in response to a published request for comments by the Committee, must include on his statement or submission a list of all clients, persons, or organizations on whose behalf the witness appears.
4. A supplemental sheet must accompany each statement listing the name, company, address, telephone and fax numbers where the witness or the designated representative may be reached. This supplemental sheet will not be included in the printed record.
The above restrictions and limitations apply only to material being submitted for printing. Statements and exhibits or supplementary material submitted solely for distribution to the Members, the press and the public during the course of a public hearing may be submitted in other forms.
The
Committee seeks to make its facilities accessible to persons with
disabilities. If you are in need of special accommodations, please
call 202-225-1721 or 202-226-3411 TTD/TTY in advance of the event
(four business days notice is requested). Questions with regard to
special accommodation needs in general (including availability of
Committee materials in alternative formats) may be directed to the
Committee as noted above.