S. 1335
"Justice for Medicare beneficiaries Act of 2005"



Background

 

Sec. 931 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) requires the transfer of the Medicare appeals process from the Social Security Administration (SSA) to the Department of Health and Human Services (HHS).  A proposed rule issued last month indicates that current HHS plans to bring about this transfer will significantly and negatively affect Medicare beneficiaries’ ability to seek redress from the denial of benefits such as access to prescription medicines, home health services, and services provided at skilled nursing facilities. 

 

Specifically, the Administration’s proposed transfer plan will reduce the number of sites where these appeal hearings can take place to four from the more than 140 sites currently operating nationwide.  Today, Medicare beneficiaries that have filed coverage appeals are granted a hearing before an Administrative Law Judge (ALJ).  Under the proposed transfer plan, Medicare beneficiaries will now have their hearings heard via tele- or video conference and will only be allowed to appear in person by request and if HHS determines that “special or extraordinary circumstances exist.”  Moreover, beneficiaries granted an in-person hearing would not be assured that their cases would be heard within the 90-day window currently mandated by law.  Lastly, the proposed transfer plan will endanger the independence and impartiality of Administrative Law Judges by requiring them to defer to program guidance provided by the Centers for Medicare and Medicaid Services (CMS) rather than on the Medicare statute and regulations, as they currently do.  

 

Summary

 

Senator Dodd’s Justice for Medicare Beneficiaries Act of 2005 will ensure that Medicare beneficiaries who are denied benefits that bear on their health can appeal these denials in a meaningful way.  It will ensure that Medicare beneficiaries have access to timely, impartial, and in-person hearings before Administrative Law Judges.

 

The Justice for Medicare Beneficiaries Act of 2005 will:

  1. Allow Medicare appeals to be heard in person before an ALJ.  Any beneficiary may alternatively choose to have their hearing heard via tele- or video conference.
     

  2. Require that all appeal hearings, regardless of whether a Medicare beneficiary appears in person or chooses to appear via tele- or video conference, will be heard within 90 days of filing an appeal as mandated by the Benefits Improvement and Protection Act of 2000.
     

  3. Require at least one site for the hearing of in-person Medicare appeals in each state, the District of Columbia, and territories, plus an additional site in the nation’s five largest states geographically distributed in the state.
     

  4. Ensure the independence and impartiality of ALJs by relieving them of the proposed transfer plan’s mandate to grant “substantial deference” to CMS program guidance.


STATEMENT BY SENATOR CHRISTOPHER J. DODD
Introduction of The Justice for Medicare Beneficiaries Act of 2005

June 29, 2005


Mr. President, I rise today to introduce the Justice for Medicare Beneficiaries Act of 2005, legislation that will ensure that Medicare beneficiaries who are denied health-related benefits can appeal these denials in a meaningful way.  Very simply, this initiative will ensure that Medicare beneficiaries have access to timely, impartial, and in-person hearings before Administrative Law Judges.

 

Mr. President, Sec. 931 of the Medicare Prescription Drug, Improvement, and Modernization Act requires the transfer of the Medicare appeals process from the Social Security Administration (SSA) to the Department of Health and Human Services (HHS).  A proposed rule recently put forth indicates that current HHS plans to bring about this transfer will significantly and negatively affect Medicare beneficiaries= ability to seek redress from the denial of benefits such as access to prescription medicines, home health services, and services provided at skilled nursing facilities.

 

Specifically, the Administration=s proposed transfer plan, slated to go into effect in only a handful of days on July 1, will reduce the number of sites where these appeal hearings can take place to four from the more than 140 sites currently operating nationwide.  Today, Medicare beneficiaries that have filed coverage appeals are granted a hearing before an Administrative Law Judge (ALJ).  Under the proposed transfer plan, Medicare beneficiaries will now have their hearings heard via video- or teleconference (VTC) and will only be allowed to appear in person by request and if HHS determines that "special or extraordinary circumstances exist."  Moreover, beneficiaries granted an in-person hearing would not be assured that their cases would be heard within the 90-day window currently mandated by law.  Lastly, the proposed transfer plan will endanger the independence and impartiality of Administrative Law Judges by requiring them to defer to program guidance provided by the Centers for Medicare and Medicaid Services (CMS) rather than on the Medicare statute and regulations, as they currently do.

 

Mr. President, central to our system of justice is the right of aggrieved parties to appear before an impartial judge in person to have their cases heard.  Appearing face-to-face before an impartial trier of fact is the best way to ensure that a full and fair hearing occurs.  In person hearings allow parties to fully make their case.  At the same time, they allow judges to best evaluate the demeanor and condition of the parties, and other aspects of a case.  The Administration's proposed rule transferring the Medicare appeals process from SSA to HHS greatly endangers this right by gutting the current practice of guaranteeing the right of Medicare beneficiaries to appear in person before an ALJ when having their appeals heard and instead will now presume that these hearings will be heard via video- or teleconference.

 

Often when we talk about the denial of Medicare benefits, we are talking about the denial of services that literally have the ability to save lives.  Medicare provides a critical safety net for millions of elderly and disabled beneficiaries and the proposed transfer plan's almost wholesale reliance on novel VTC technology may endanger the ability of many Medicare beneficiaries to accurately and personally portray the severity of their own health conditions.

 

The Justice for Medicare Beneficiaries Act of 2005 will ensure those Medicare beneficiaries that have filed coverage appeals have access to timely, impartial, and in-person hearings before Administrative Law Judges.  Specifically, this initiative will ensure that Medicare appeals will be heard in person before an ALJ, as they presently are.  While all Medicare beneficiaries will be entitled to appear in person for their hearing, any beneficiary may choose to have their hearing heard via video or teleconference.

 

Mr. President, the legislation that I introduce today is in no way designed to prevent the adoption of the promising technology represented by VTC.  Rather, this initiative simply seeks to preserve the critically important ability of Medicare beneficiaries to appear before the very judges charged with hearing their coverage appeals.  By preventing the great majority of Medicare beneficiaries from appearing in person before the judge hearing their Medicare appeals, the Administration's proposed plan will greatly harm their ability to accurately and completely present all of the facts relevant to their case.  And while I understand that many Medicare beneficiaries will choose to have their appeals heard via either video- or teleconference, I believe that we must preserve for Medicare beneficiaries the ability to appear in person before a judge when their cases are heard.

 

The legislation will also require that all Medicare coverage appeal hearings, regardless of whether a Medicare beneficiary appears in person or chooses to appear via video- or teleconference, will be heard within 90 days as mandated by the Benefits Improvement and Protection Act of 2000.  All Medicare beneficiaries deserve to have their appeals heard in a timely manner regardless of whether their cases are heard in person or via utilizing VTC technology.

 

The Justice for Medicare Beneficiaries Act will also address the Administration's plans to reduce the number of sites where Medicare appeal hearings may be heard in person from the more than 140 sites currently available to four.  This legislation will require at least one site for the hearing of in-person Medicare appeals in each state, the District of Columbia, and territory, with the nation's five largest states featuring two hearing sites geographically distributed throughout the state.

 

Lastly, Mr. President, this legislation will ensure the independence and impartiality of Administrative Law Judges by relieving them of the proposed transfer plan's mandate to grant "substantial deference" to CMS program guidance.  Medicare beneficiaries appealing coverage decisions should be fully confident that the judges deciding their appeals are bound only by the merits of their case and not undue pressure from agency of administration interference.

 

Mr. President, I want to thank Senators Kennedy, Kerry, and Bingaman for joining me in sponsoring this important initiative.  The Justice for Medicare Beneficiaries Act is also supported by a number of national and local organizations dedicated to preserving the continued ability of Medicare beneficiaries to access needed health care services.  Endorsing the legislation that I introduce today are the Center for Medicare Advocacy located in my own state of Connecticut, the National Health Law Program, the National Senior Citizens Law Center, the Medicare Advocacy Project of Vermont Legal Aid, the Medicare Advocacy Project of Greater Boston Legal Services, and the Senior Citizens' Law Office of Albuquerque, NM.

 

Mr. President, in Congress we far too rarely have the opportunity to stave off problems before they occur.  Rather, too often we are forced to involve ourselves in matters only after they have already wreaked havoc on the lives of our constituents.  With passage of the Justice for Medicare Beneficiaries Act of 2005, we have the opportunity to avoid the adverse impact that the Administration's proposed transfer plan will likely have on Medicare beneficiaries.  This legislation will preserve for our nation's 41 million Medicare beneficiaries the ability to timely appear in person before judges who will impartially determine which health care services they're entitled to receive under Medicare.  Medicare beneficiaries deserve no less than the vital protections offered by this act and I ask for the support of my colleagues for this critically important initiative.


CO-SPONSORS
(As of 07/07/05)


CO-SPONSORS OF S. 1217

Sen Bingaman, Jeff [NM] - 6/29/2005
Sen Kennedy, Edward M. [MA] - 6/29/2005
Sen Kerry, John F. [MA] - 6/29/2005

Up-to-the minute information on co-sponsor's is available at http://thomas.loc.gov/bss/d109query.html.
Simply enter S. 1217 for Senate information or H.R.2869 for House of Representatives information.


Supporting Organizations


Center for Medicare Advocacy

Medicare Advocacy Project of Greater Boston Legal Services

Medicare Advocacy Project of Vermont Legal Aid

National Health Law Program

National Senior Citizens Law Center

Senior Citizens' Law Office of Albuquerque, NM.


Copyright © Center for Medicare Advocacy, Inc. 09/10/2013