Still, Buck said otolaryngologists and others can take positives from the bill in that the proposed 2016 budget for the U.S. Department of Health and Human Services (HHS) reflects some of the bill’s recommendations. For example, Medicare magistrates, who could hear cases for overworked administrative law judges (ALJs), were included in HHS’ budget after hearings were held on the proposed act. “We must assume that both (Sens.) Hatch and Wyden knew the outcome of their bill beforehand, that it wouldn’t pass,” Buck said. “Nonetheless, they convened hearings and drafted the legislation, which will now, most likely, not be passed but instead will end up as policy.”
The proposal to reform the RA program comes as it struggles with efficacy and success. The Office of Medicare Hearings and Appeals can’t docket appeals for 20 to 24 weeks, Sens. Hatch and Wyden announced over the summer in prompting their bill. In fact, in fiscal year 2009, the majority of appeals were processed in 94 days. In fiscal year 2015, it is expected to take an average of 604 days—more than 18 months.
In addition, some 60% of the 41,000 appeals made to ALJs in fiscal year 2012 were “partially or fully favorable to the defendant,” the senators said in an announcement. “Such a high rate of reversals raises questions about the quality of initial determinations and whether providers and beneficiaries are facing undue burdens on the front end,” they added.