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Two years ago, federal lawmakers ordered the Centers for Medicare and Medicaid Services to change the Medicare appeals process drastically. The revised appeals system would offer faster review times, and grant providers and beneficiaries better access to the appeals system.

However, CMS announced Oct. 7 it would not be able to implement all of the changes that Congress mandated in the Benefits Improvement and Protection Act before the Act's Oct. 1, 2002, deadline.

Citing the need for “additional policy development,” additional resources and additional guidance from Congress, CMS said the agency is not yet able to issue initial determination decisions within 45 days; is not yet able to issue redetermination decisions within 30 days; has not yet hired “qualified independent contractors” to review redeterminations; and is not yet ready to implement escalation provisions that allow providers and beneficiaries to appeal slow-moving cases to a federal court.

Nonetheless, CMS has made progress toward implementing BIPA's appeals provisions, the agency said. The steps CMS has taken include:

• reducing the 180-day deadline for filing requests for Part B redeterminations to 120 days;

• developing a “request for proposals” to solicit bids from potential “qualified independent contractors;”

• creating a central appeals case-tracking system; and

• revising the various appeals forms.

More information about the status of CMS' Medicare appeals system reforms is available in the Oct. 7 Federal Register, at http://www.access.gpo.gov/su_docs/fedreg/a021007c.html, under the heading “Centers for Medicare and Medicaid Services.”

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