Fiscal Year 2010 Budget in Brief

Office of the Secretary
Office of Medicare Hearings and Appeals

(dollars in millions)

The Office of Medicare Hearings and Appeals provides an independent forum for the fair and efficient adjudication of Medicare appeals for beneficiaries and other parties. This mission is carried out by a cadre of knowledgeable Administrative Law Judges exercising judicial and decisional independence under the Administrative Procedures Act, with the support of a professional legal and administrative staff.

The FY 2010 Budget requests $71 million for the Office of Medicare Hearings and Appeals (OMHA), a net increase of $6 million over FY 2009. Funds are being requested from the Federal Hospital Insurance and Supplementary Medical Insurance Trust Funds to hear cases under Title XVIII of the Social Security Act, and related provisions in Title XI of the Act.

OMHA was established by Public Law 108 173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). MMA transferred the responsibility for hearing Medicare appeals at the Administrative Law Judge (ALJ) level – the third level of Medicare claims appeals – from the Social Security Administration to the HHS Office of the Secretary. In addition, the Medicare Benefits Improvement and Protection Act of 2000 (BIPA) mandated that such ALJ appeals be heard within 90 days after receipt of a request from a Medicare appellant for a hearing. OMHA began processing cases on July 1, 2005; to date it has received almost 550,000 claims from across the United States for Medicare Parts A, B, C, and D appeals, as well as Medicare entitlement and eligibility appeals. During FY 2008, OMHA received a total of 183,326 claims, an increase of 33 percent over its FY 2007 caseload.

OMHA administers appeals in four field offices, including the Southern Field Office in Miami, Florida; the Midwestern Field Office in Cleveland, Ohio; the Western Field Office in Irvine, California; and the Atlantic Field office in Arlington, Virginia. OMHA extensively utilizes hearings held via video-teleconference (VTC) and telephone, in order to provide appellants with hearings which are timely, close to their homes, and with a broad array of access points. VTC technology, which is commonly used throughout the country in courtrooms and for telemedicine, plays a critical role in OMHA’s ability to both meet the BIPA timeframes and provide expanded access for appellants to ALJ hearings.

In FY 2010, OMHA projects that it will receive 36 percent more claims than in FY 2009, including claims resulting from the permanent expansion to all 50 States of the Recovery Audit Contractor (RAC) program administered by the Centers for Medicare & Medicaid Services. The demonstration phase of the RAC program in FY 2008 and FY 2009 included just five States.

With the requested funding level of $71 million, OMHA will be able to process the projected ALJ appeals workload within the BIPA mandated timeframes. OMHA will accomplish this by continuing to utilize state-of-the-art technology, maintain necessary staffing levels, and offer high levels of access for appellants to hearing sites and services.

FY 2010 Budget in Brief Home