Timeliness and a fair opportunity to be heard are distinct obligations. HHS’s Medicare appeals final rule, published January 17, 2017, placed specified non-hearing work with attorney adjudicators rather than requiring administrative law judges to perform every task. The ethical question is not whether speed is good in isolation, but whether the allocation of work respects the kind of decision an appellant needs. [2016-32058]

The scale explains why timeliness mattered to the proposal. Its July 2016 account recorded more than 750,000 pending appeals on April 30 and annual capacity of 77,000. The final document described more than 650,000 pending on September 30 and approximately 92,000 in annual capacity. These are appeals, not a count of individual people whose experiences can be read directly from the totals. [2016-32058][2016-15192]

The rule’s attorney routes included specified decisions without a hearing, dismissals after a hearing request was withdrawn, certain remands and reviews of dismissals. HHS estimated a possible redirection of about 24,500 appeals annually. That forecast did not prove quicker decisions, and the defined routes should not be confused with eliminating applicable hearing protections. [2016-32058]

The publication scheduled March 20, 2017 effectiveness. Both workload snapshots preceded that date, so attributing their difference to the rule would substitute a reassuring story for evidence. A responsible assessment can value administrative efficiency and procedural dignity together. The documents explain how HHS proposed to distribute responsibility; they do not establish that either obligation was fully met. [2016-32058][2016-15192]

Source documents

  1. Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedureshttps://www.govinfo.gov/content/pkg/FR-2017-01-17/html/2016-32058.htm
  2. Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedureshttps://www.govinfo.gov/content/pkg/FR-2016-07-05/html/2016-15192.htm