Pursuant to the settlement agreement in Exley v. Burwell, a class action brought by the Center to address delays in appeals at the Administrative Law Judge (ALJ ) level, the Office of Medicare Hearings and Appeals (OMHA) has established a new help line to troubleshoot beneficiary appeals. In a September 1, 2016 announcement, OMHA introduced the toll-free Beneficiary Help Line: (844) 419-3358. This line, which is staffed by representatives of OMHA, will address inquiries about ALJ appeals being pursued by Medicare beneficiaries. Under the Exley settlement, OMHA is required to continue its policy of putting beneficiary appeals at the front of the line. This should drastically reduce the wait time for a decision that is currently faced by other appellants (mostly medical providers). ALJ decisions are required by law to be issued within 90 days of the receipt of the request for a hearing.
The Center urges anyone pursuing a beneficiary appeal who believes the appeal is not receiving timely attention to call the Beneficiary Help Line. The expectation is that a call to this line will help resolve delays in cases that are eligible to be prioritized. The Beneficiary Help Line is staffed from 8:00 a.m. to 4:30 p.m., Eastern Time. If calling at other times or if the OMHA Beneficiary Help Line staff are assisting other callers, OMHA instructs callers to leave a voicemail. Please report your experiences using the Help Line to the Center at: email@example.com.
Also as a result of the Exley Settlement, in February 2017, OMHA will be issuing a revised ALJ hearing request form that will make it easier for beneficiaries to identify themselves and thus receive prioritization. Until then, beneficiary appellants should continue to clearly and boldly indicate on their appeal requests that they are a “BENEFICIARY APPELLANT.” They should also continue to use the “Beneficiary Mail Stop” as indicated in the current mailing instructions for ALJ appeals.