Last week, the United States Court of Appeals for the District of Columbia Circuit reversed and remanded the Medicare appeals backlog case American Hospital Association v. Price to the district court. As previously reported, in December 2016, the district court had ordered HHS to comply with a timeline to reduce the appeals backlog pending before the Office of Medicare Hearings and Appeals (OMHA). HHS filed a motion for reconsideration, which the district court denied, leading to HHS’s appeal to the Circuit Court. The Circuit Court found that the district court had failed to adequately consider HHS’s argument that eliminating the appeals backlog was actually impossible within the timeline set by the district court.

Throughout the case, HHS has claimed that eliminating OMHA’s appeals backlog would be impossible without additional congressional appropriations. While the President’s proposed fiscal year 2018 budget doubled OHMA’s funding, those allocations have not yet been approved by Congress. According to the Circuit Court, the district court made no finding of whether HHS would be able to lawfully comply with the timeline in light of OMHA’s budgetary constraints. In addition, the Circuit Court’s order instructed the district court to evaluate HHS’s claims that the timetable would increase, rather than decrease, the number of pending appeals. In its most recent status report, the government claimed that if the additional appropriations are not approved, the number of pending appeals would increase from 607,402 to 950,520 by September 30, 2021. Because the burden of proving impossibility is so high, the Circuit Court instructed that the district court could reissue its order without modification if the government could not prove impossibility.

The Circuit Court’s opinion is available here.