Sunday, March 16, 2003

This is really ugly:

From the New York Times:
Bush Pushes Plan to Curb Medicare Appeals

The Bush administration says it is planning major changes in the Medicare program that would make it more difficult for beneficiaries to appeal the denial of benefits like home health care and skilled nursing home care.


In the last year, Medicare beneficiaries and the providers who treated them won more than half the cases — 39,796 of the 77,388 Medicare cases decided by administrative law judges.     ...     Under federal law, the judges are independent, impartial adjudicators who hold hearings and make decisions based on the facts. They must follow the Medicare law and rules, but are insulated from political pressures and sudden shifts in policy made by presidential appointees.

President Bush is proposing both legislation and rules that would limit the judges' independence and could replace them in many cases. The administration's draft legislation says, "The secretary of health and human services may use alternate mechanisms in lieu of administrative law judge review" to resolve disputes over Medicare coverage. Under the legislative proposal, cases could be decided by arbitration or mediation or by lawyers or hearing officers at the Department of Health and Human Services.


That would be a significant change. Administrative law judges are now required to follow Medicare statutes and regulations, but not the agency's policies. As a result, the judges often grant benefits previously denied by the Medicare agency or its contractors.


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