Originally Published MX March/April
2002
BUSINESS NEWS
CMS Delays Draw Congressional Rebuke
Lack
of progress by the Centers for Medicare and Medicaid Services (CMS; Baltimore)
toward the implementation of reforms in the Medicare coverage and appeals processes
has drawn sharp criticism from the House Committee on Ways and Means and its
subcommittee on health.
In a February letter, Committee on Ways and Means chairman Bill Thomas (R–CA)
criticized the fact that the proposed budget for fiscal year 2003 submitted
by the Bush administration included no funding for implementing coverage and
appeals reforms required by the Benefits Improvement and Protection Act of 2000
(BIPA). The letter was sent to Department of Health and Human Services (HHS)
secretary Tommy Thompson and CMS administrator Thomas Scully. The letter was
also signed by Charles B. Rangel (D–NY), ranking member of the Ways and
Means Committee, and Nancy L. Johnson (R–CT) and Pete Stark (D–CA),
respectively chair and ranking member of the subcommittee on health.
Sections 521 and 522 of BIPA would establish new rights of appeal for Medicare
beneficiaries and create a process for third-party reviewers, called qualified
independent contractors, to reconsider local coverage determinations. Without
administrative funding in the 2003 budget, CMS would be unable to begin selecting
qualified independent contractors until 2004. "This is unacceptable,"
noted Thomas, who said the third-party reviewers are "critical to achieving
a faster, more independent appeals process."
CMS had earlier issued a ruling delaying full implementation of the BIPA reforms
"until final regulations are issued." In the September 2001 ruling,
the agency argued that delayed implementation was necessary because "it
is important to establish final regulatory guidance on these provisions with
the benefit of public notice and comment before the provisions are fully implemented."
The BIPA sections also impose statutory time frames for Medicare national coverage
determinations and include significant changes in the processes used by the
Medicare Coverage Advisory Committee. Implementation of the provisions is expected
to improve the timeliness and openness of Medicare coverage processes, for which
medtech manufacturers have criticized CMS performance over the past few years.
"These provisions are in the law because, according to CMS, if an appeal
goes through the departmental appeals board level, the process takes, on average,
1214 days," Thomas wrote. "It seems no exaggeration, as beneficiary
advocates state, that some beneficiaries are dead before their appeals are decided.
"We do not support extensions to the statutory deadlines because we have
not lost sight of why these changes were made to the Medicare program,"
continued Thomas. "The time frame is not discretionary and we expect CMS
to proceed with implementation
of the law."
Copyright ©2002 MX
