Sunday, January 12, 2014

New CMS Office Handling Both Exchange And Medicare Complaints

The Centers for Medicare and Medicaid Services (CMS) has created a new office to handle complaints and appeals under the Affordable Care Act’s health insurance marketplace as well grievances and some provider appeals under Medicare according to Inside Health Policy. The new Office of Hearings and Inquiries (OHI) will be led by former Medicaid Program Integrity Group Director Angela Brice-Smith.

 Listed in a recent Federal Register notice, as part of the move to consolidate all complaints under a single office, CMS has eliminated its Office of Public Engagement (OPE) and is moving several of OPE's functions into the newly created OHI. According to inside Health Policy, consumers will be able to go through the new office to appeal a range of marketplace decisions, including eligibility to purchase a plan in general, the amount of federal subsidies available, and eligibility for an exemption from the individual mandate. CMS recently posted appeals forms on Healthcare.gov. 

 In addition to the handling appeals for consumers in the exchanges through a newly created Office of Marketplace Eligibility Appeals, OHI is also tasked with assisting Medicare beneficiaries with complaints, inquiries and grievances, and in gathering information necessary to file Medicare appeals. The new office will also handle administrative hearings or appeals under the jurisdiction of the Provider Reimbursement Review Board, Medicare Geographic Classification Review Board and CMS Hearing Office, the agency told Inside Health Policy. 

 Functions of the now-defunct Office of Public Engagement are shifted as follows: The Medicare Ombudsman is moved to OHI, tribal affairs is moved to the Center for Medicaid and CHIP Services, and emergency preparedness is shifted to the Consortium for Quality Improvement and Survey & Certification Operations. Also, the Office of Hearings is moved from the Office of Operations Management to OHI.

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