New Medicare rules to affect hearings

Policy aims to cut back appeals made in person


WASHINGTON - A new federal policy will make it significantly more difficult for Medicare beneficiaries to obtain hearings in person before a judge when the government denies their claims for home care, nursing home services, prescription drugs and other treatments.

For years, hearings have been held at more than 140 Social Security offices around the country. In July, the Department of Health and Human Services will take over the responsibility, and department officials said all judges would then be located at just four sites - in Cleveland; Miami; Irvine, Calif.; and Arlington, Va.

Under the new policy, Medicare officials said, most hearings will be held with videoconference equipment or by telephone. A beneficiary who wants to appear in person before a judge will have to show that "special or extraordinary circumstances exist," the rules say.

And a beneficiary who insists on a face-to-face hearing will lose the right to receive a decision within 90 days, the deadline set by statute.

The policy change comes as administration officials are predicting an increase in the volume of cases, with the creation of a Medicare drug benefit expected to generate large numbers of claims and appeals. But in a recent study, the Government Accountability Office, an investigative arm of Congress, questioned the reliance on videoconferences, saying that "beneficiaries are often uncomfortable using videoconference facilities and prefer to have their cases heard face to face."

All beneficiaries are 65 or older or disabled. About 5 million of the 41 million beneficiaries are 85 or older, and some are so sick they die while pursuing appeals.

When claims are denied, beneficiaries and their health care providers can challenge the decisions in an appeals process that has several levels of review. Their best chance to win coverage comes when they appear before impartial, independent adjudicators known as administrative law judges.

Over the past five years, beneficiaries and providers prevailed in two-thirds of the 283,000 cases decided by these judges.

The Department of Health and Human Services defended its new policy, saying the use of videoconference equipment would enable judges to "complete more cases" within the 90-day deadline, because they would not have to spend time traveling to remote sites. In a summary of its plans, the department said it was "not economically or administratively feasible" to station judges around the country.

"Having fewer offices is more cost-effective in terms of management, technology and training," the department said in a letter answering questions from Congress.

Michael O. Leavitt, the secretary of health and human services, said, "Access to hearings for Medicare beneficiaries will be as good as or better than" what is now available. For some beneficiaries, he said, video hearings could be more convenient.

"Video teleconferences will allow hearings to be provided more timely, with vastly more access points than Social Security currently provides through its offices," Leavitt said.

But lawmakers, judges, consumer groups and lawyers for beneficiaries expressed concern.

Sen. Charles E. Grassley, the Iowa Republican who is chairman of the Finance Committee, and Sen. Max Baucus of Montana, the senior Democrat on the panel, said four hearing offices were not enough.

Grassley and Baucus were among the principal authors of the 2003 Medicare law. The law, they noted, says Medicare judges are to be distributed "throughout the United States."

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