In a status report filed in connection with the American Hospital Association v. Price case, HHS projects significant reductions to the Medicare appeals backlog if the “legislative and budgetary measures proposed” in the President’s FY 2018 budget are implemented.

As previously reported, the court in American Hospital Association granted a writ of mandamus directing HHS to eliminate the Medicare appeals backlog by the start of 2021.  In addition, the court ordered HHS to file status reports on its progress every 90 days.  According to the HHS June 5, 2017 status report, there are 607,402 pending appeals at the Office of Medicare Hearings and Appeals (OMHA). At current funding levels, the status report projects the number of appeals to be 594,227 by September 30, 2017; 646,711 by September 30, 2018; 739,392 by September 30, 2019; 828,336 by September 30, 2020; and 950,520 by September 30, 2021. 

If HHS takes into account the measures proposed in the President’s budget, HHS’s projections of pending reports decrease dramatically to: 594,227 by September 30, 2017; 615,294 by September 30, 2018; 519,475 by September 30, 2019, 419,919 by September 30, 2020; and 353,603 by September 30, 2021.  According to the status report, the “new legislative and budgetary measures” that are relevant include:

• “a request for additional resources for Medicare appeals, some of which would fund additional ALJ adjudication teams”;
• “a provision for remand of appeals to the first level upon the introduction of new evidence at the ALJ level”;
• “a proposal to increase the minimum amount-in-controversy for ALJ adjudication”;
• “a proposal for magistrate adjudication of cases below the new ALJ amount-in-controversy threshold”; and
• “a request to authorize expedited procedures for claims with no material fact in dispute.”

In addition, HHS “continues to pursue and implement additional measures,” such as “the expansion of the pool of available OMHA adjudicators, an initiative to increase decision-making consistency across the levels of appeal, modifications to the statistical sampling option, and efforts to streamline the appeals process.”  Without additional resources, however, HHS remains skeptical that it can meet the court-ordered reductions to the Medicare appeals backlog.

The June 5, 2017 status report can be found here.  The President’s budget can be found here.