ALJ Delays: Appellants win latest battle against CMS

Blog Post
The third level of appeal (the five-level Medicare appeals process is the subject of another blog post) is a request for a hearing before an Administrative Law Judge (ALJ). By law, the ALJ has 90 days from when a hearing is requested to hold a hearing and render a decision. Pursuant to the most recent statistics from the Office of Medicare Hearings and Appeals (OMHA) website1 the average processing time for 2017 (yes, the current year) is over a thousand days. The chart is reproduced at the bottom of this post if you are interested in seeing the progression of the increased processing times since 2009. 
This absurd backlog caused the American Hospital Association (AHA), along with three hospitals to file a complaint to compel the Department of Health and Human Services (HHS) to comply with the 90-day statutory deadline. In December 2016, the D.C. Circuit District Order granted the AHA’s request and ordered HHS to eliminate the ALJ backlog by December 31, 2020. It is very likely that HHS will appeal to the D.C. Circuit Court. If the decision survives appeal, it will be good news for providers currently in the midst of the five-level Medicare appeals process.
Average Processing Time by Fiscal Year
Fiscal Year      Number of Days
FY09 94.9
FY10 109.6
FY11 121.3
FY12 134.5
FY13 220.6
FY14 414.9
FY15 661.8
FY16 877.2
FY17 1041.5

1 Accessed February 24, 2017 

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