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*** For Appeals Submitted After April 1, 2013 ***

Due to the overwhelming number of receipts and the existing workload within the Agency, OMHA implemented a program that defers the assignment of most requests for hearing received after April 1, 2013.  Under this new docketing process, new requests for hearing will be entered into our case processing system, then held until they can be accommodated on an Administrative Law Judge's docket for adjudication.  Due to the volume of requests that we are receiving, there are significant delays in assigning requests at this time.  When your request is assigned to an Administrative Law Judge, we will send you a Notice of Assignment.  Based on our current workload and volume of new requests, we anticipate that assignment of your request for hearing to an Administrative Law Judge may be delayed for up to 28 months.

Please note that we will continue to process Part D prescription drug denial cases that qualify for expedited status within 10 days and will screen all incoming requests to ensure Medicare beneficiary issues are prioritized given that they often present emergent circumstances that must be promptly addressed.

FILING INSTRUCTION ALERT TO 

OMHA APPELLANTS

In order to manage the volume of appeals we are receiving, we ask that you please do the following:

  • Do not attach medical records or other documentary evidence to your request for Administrative Law Judge (ALJ) hearing.  Please limit your submission to the Request for ALJ hearing itself.  See the “When to Submit Your Evidence” section below for instructions on how and when to submit additional evidence.

 

  • Clearly list the Medicare Appeal Number for the Reconsideration you are appealing on your Request for ALJ hearing form.  This number will appear in the upper right-hand corner of the reconsideration decision letter in the following format, e.g. 1-1234567890.  Alternatively, please include a copy of the first page of your reconsideration decision. 

 

  • If you are appealing a reconsideration issued by a Qualified Independent Contractor (QIC), DO NOT submit a courtesy copy of your request for ALJ hearing to the QIC who issued your reconsideration or to the Medicare Administrative Contractor (MAC) who issued your redetermination.  Neither the QIC nor the MAC require a copy for the purposes of 42 CFR § 405.1014(b)(2). 

 

  • Do not re-submit medical records or other documentary evidence you already submitted earlier in the claim submission or to another level of appeal.  When you request an ALJ hearing, OMHA coordinates directly with the prior level of appeal to obtain the administrative record, which includes everything you already submitted.  Duplicate evidence will not be considered.

 

OMHA requests all previously submitted medical records or other documentary evidence from the Prior Appeal Level. The documents are then forwarded to OMHA for consideration.    

 

WHEN TO SUBMIT YOUR EVIDENCE

  • When your request for hearing is assigned to an ALJ, we will send you a Notice of Assignment.  This notice will reflect the name and address of the ALJ assigned to your case.  If you would like to submit additional evidence related to your appeal, you should submit it after assignment directly to your assigned ALJ using the name and address referenced on this notice.   Alternatively, you may submit your evidence directly to the ALJ within ten calendar days of receipt of the Notice of Hearing.

 

Special instruction for providers or suppliers: if you are submitting new evidence to the ALJ that was not previously submitted at any prior level of appeal, the evidence must be accompanied by a statement explaining why the evidence was not previously submitted.  See 42 CFR § 405.1018.  The ALJ will then examine any new evidence to determine whether there is good cause to submit the evidence for the first time at the ALJ level.  42 CFR § 405.1028.