Grassley, Wyden Introduce Bill to Tackle Medicare Appeals Backlog

Washington – Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) reintroduced legislation to reduce the backlog of Medicare appeals cases. The bipartisan Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act (AFIRM) of 2019, establishes new tools for the Office of Medicare Hearing and Appeals (OMHA) at the Department of Health and Human Services (HHS) to resolve outstanding appeals cases in a more efficient and cost-effective manner.

“HHS has made great strides to reduce the backlog of Medicare appeals at OMHA. However, despite their best efforts, more than 300,000 Medicare appeals were still pending as of June this year. As a result, hospitals, doctors and nursing homes are being forced to wait for up to three years for their appeal to be adjudicated. This bill gives HHS the ability to eliminate the backlog more quickly and help prevent bottlenecks in the future,” Grassley said.

 

“Care providers and seniors shouldn’t have to wait years for the federal government to determine it has improperly denied a health care claim and compensate them accordingly. This bipartisan bill has been before Congress for far too long. I thank Chairman Grassley for continuing this bipartisan work and I hope it can become law soon to finally eliminate this backlog,” Wyden said.

The AFIRM Act (S.3078) builds on the Committee’s past oversight and investigative efforts to identify ways to make Medicare appeals more efficient for healthcare providers. In 2015, an earlier version of the AFIRM Act was passed out of the Senate Finance Committee by unanimous consent, but failed to pass the Senate. Since the beginning of the year, Grassley and Wyden have worked to identify opportunities to reduce costs associated with the bill. Earlier versions of the bill were estimated to cost more than $1 billion over a ten year period, while this version is expected to cost just a fraction of that amount.

 

The legislation introduced this week would help HHS adjudicate low-value claims by providing HHS the authority to establish the Medicare magistrate program. This policy would enable Administrative Law Judges to focus on more complex and higher amount in controversy appeals, while ensuring that all appealed claims are adjudicated. Granting HHS the authority to establish the Medicare magistrate program addresses these issues and provides the Department with a more flexible workforce. Additionally, this aspect of the bill saves taxpayer dollars, by providing non-hearing alternatives to an otherwise costly appellate process.

 

Legislative text of the AFIRM Act is available HERE.