The Department of Health and Human Services (HHS) Departmental Appeals Board (DAB) has requested suggestions for Medicare Appeals Council (Council) decisions that should be designated as precedential. The Council provides the fourth and final level of administrative review in the Medicare appeals process.
The ability to authorize certain Council decisions as precedential was a change included in the HHS Final Rule on Medicare Appeals, effective March 20, 2017. Under the HHS Final Rule, precedential Council decisions will be binding, including on HHS and the Centers for Medicare & Medicaid Services (CMS). The DAB will publish notice of precedential designations in the Federal Register, and copies of precedential decisions will be posted on the DAB’s website.
HHS explained that they believe the designation of certain decisions as precedential will increase consistency throughout the appeals process, therefore reducing resources required to issue decisions and potentially reducing appeal rates by providing greater clarity to appellants and adjudicators. Further, HHS expects that precedential decisions will facilitate earlier resolution of certain appeals, potentially resulting in fewer appeals at the third and fourth level.
The DAB has requested that interested parties submit suggestions for Council decisions that should be designated as precedential, issues that should be addressed by precedent, or other suggestions regarding precedential decisions. Suggestions may be emailed to DABStakeholders@hhs.gov. The DAB has indicated that it will review all suggestions, but is unable to respond to each individual submission.
The DAB announcement is available here.
