Part A Alerts
MAXIMUS Federal Services Awarded QIC Part A West Task Order
9/23/08 -- CMS recently competed and awarded the QIC Part A West Task Order to MAXIMUS Federal Services. Under this task order, MAXIMUS will process Part A standard reconsiderations of FI/AC and A/B MAC redeterminations for the West jurisdiction. MAXIMUS also will process Part A expedited reconsiderations of QIO redeterminations for the West jurisdiction. All redeterminations issued on or after December 8, 2008, by contractors that process claims in the West jurisdiction, will instruct appellants on the Medicare Redetermination Notice to file reconsideration requests with Maximus.
Contractors shall continue to refer appellants to the current Part A West QIC, First Coast Service Options, Inc. (FCSO), until Maximus becomes operational on December 14, 2008. Because FCSO will be processing appeals received prior to December 14, 2008, there will be a short transition period during which both FCSO and Maximus will be issuing decisions. Thus, contractors will be expected to work with both QICs during this time.
Calendar Year 2009 Amount in Controversy ("AIC") Threshold Amounts Announced
9/12/08 -- CMS has announced the annual adjustment in the AIC threshold amounts for Administrative Law Judge ("ALJ") hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on or after January 1, 2009. The AIC threshold amount for ALJ hearing requests will be $120 (no change compared to 2008), and the AIC threshold amount for judicial review will be $1,220 (up from $1,180 presently in effect for calendar year 2008).
ALJ Requests
12/12/07 -- The purpose of this memorandum is to notify the Qualified Independent Contractors (QICs) of the increase in the amount in controversy required to sustain appeal rights beginning January 1, 2008. The Medicare Prescription Drug, Improvement, and Modernization Act provides for annual reevaluation, which began in 2005, of the dollar amount in controversy required for an Administrative Law Judge (ALJ) hearing or Federal District Court review. The amount in controversy increases by the percentage increase in the medical care component of the consumer price index for all urban consumers (U.S. city average) for July 2003 to the July preceding the year involved. Any amount that is not a multiple of $10 will be rounded to the nearest multiple of $10.
The amount that must remain in controversy for ALJ hearing requests made before January 1, 2008 is $110. The amount will increase to $120 for requests made on or after January 1, 2008. The amount that must remain in controversy for Federal District Court review before January 1, 2008 is $1130. This amount will increase to $1180 for appeals to Federal District Court made after January 1, 2008.
All QIC reconsideration decisions issued prior to January 1, 2008 should include both the new ALJ amount in controversy figures and the January 1, 2008 effective date for the new amounts. In addition, any associated materials, such as websites or correspondence that reflect these amounts should be updated accordingly.
Office of Medicare Hearings and Appeals (OMHA) Jurisdiction Change
03/01/2007 -- The Office of Medicare Hearings and Appeals (OMHA) has released an order for the purpose of changing the current jurisdiction for Medicare appeal cases arising in Puerto Rico, the Virgin Islands, and the state of Kentucky.
Effective March 18, 2007, the proper jurisdiction for any Medicare appeal originating in Puerto Rico or in the Virgin Islands shall be the Miami Office of Medicare Hearings and Appeals.
Effective March 18, 2007, the proper jurisdiction for any Medicare appeal originating in the state of Kentucky shall be the Cleveland Office of Medicare Hearings and Appeals.