I
106TH CONGRESS
1ST SESSION
H. R. 2356
To amend title XVIII of the Social Security Act to improve review procedures
under the Medicare Program by making those procedures more equitable
and efficient for beneficiaries and other claimants, and for other pur-
poses.
IN THE HOUSE OF REPRESENTATIVES
JUNE 24, 1999
Mr. THOMAS (for himself, Mr. STARK, Mrs. JOHNSON of Connecticut, Mr.
MCCRERY, Mr. SAM JOHNSON of Texas, Mr. CAMP, Mr. RAMSTAD, Mr.
ENGLISH, Mr. MCINTOSH, and Mr. LOBIONDO) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on Commerce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to improve
review procedures under the Medicare Program by mak-
ing those procedures more equitable and efficient for
beneficiaries and other claimants, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare Patient Ap-
peals Act of 1999’’.
SEC. 2. REVISION OF APPEALS PROCESS.
(a) DEADLINES
FOR
CONSIDERATION
OF
AP-
PEALS.—Section 1869 of the Social Security Act (42
U.S.C. 1395ff) is amended—
(1) in subsection (a), by inserting ‘‘consistent
with subsections (c) and (d)’’ before the period; and
(2) by adding at the end the following new sub-
sections:
‘‘(c) DEADLINES FOR RECONSIDERATIONS AND AP-
PEALS UNDER PART A.—Reconsideration and appeals
under subsections (a) and (b) with respect to matters
under part A shall be conducted consistent with the fol-
lowing:
‘‘(1) DEADLINES
FOR
ADMINISTRATIVE
AC-
TION.—
‘‘(A) RECONSIDERED
DETERMINATION.—
The Secretary shall conduct and conclude a re-
consideration of an initial determination, and
mail the notice of reconsidered determination,
by not later than the end of the 60-day period
beginning on the date a request for reconsider-
ation has been timely filed.
‘‘(B) HEARING BY ADMINISTRATIVE LAW
JUDGE.—
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), an administrative law
judge shall conduct and conclude a hearing
and render a decision on such hearing by
not later than the end of the 90-day period
beginning on the date a request for hear-
ing has been timely filed.
‘‘(ii) WAIVER OF DEADLINE BY PARTY
SEEKING
HEARING.—The 90-day period
under clause (i) shall not apply in the case
of a motion or stipulation by the party re-
questing the hearing to waive such period.
‘‘(C) DEPARTMENTAL APPEALS BOARD RE-
VIEW.—The Departmental Appeals Board of
the Department of Health and Human Services
shall conduct and conclude a review of the deci-
sion on a hearing described in subparagraph
(B) and make a decision or remand the case to
the administrative law judge for reconsideration
by not later than the end of the 90-day period
beginning on the date a request for review has
been timely filed.
‘‘(2) CONSEQUENCES
OF
FAILURE
TO
MEET
DEADLINES.—
‘‘(A) IN GENERAL.—(i) In the case of a
failure by the Secretary to mail the notice of re-
considered determination by the end of the pe-
riod described in paragraph (1)(A), the party
requesting the reconsideration may request a
hearing before an administrative law judge, not-
withstanding any requirements for a reconsid-
ered determination for purposes of the party’s
right to such hearing.
‘‘(ii) In the case of a failure by an admin-
istrative law judge to render a decision by the
end of the period described in paragraph
(1)(B), the party requesting the hearing may
request a review by the Departmental Appeals
Board of the Department of Health and
Human Services, notwithstanding any require-
ments for a hearing for purposes of the party’s
right to such a review.
‘‘(B) DAB HEARING PROCEDURE.—In the
case of a request described in subparagraph
(A)(ii), the Departmental Appeals Board shall
review the case de novo.
‘‘(d) DEADLINES
FOR
REVIEWS
AND
APPEALS
UNDER PART B.—Reviews and appeals under subsections
(a) and (b) with respect to matters under part B shall
be conducted consistent with the following:
‘‘(1) DEADLINES.—
‘‘(A) REVIEW
OF
INITIAL
DETERMINA-
TION.—A carrier shall conduct and conclude a
review of an initial determination, and mail the
notice of review determination, by not later
than the end of the 60-day period beginning on
the date a request for review has been timely
filed.
‘‘(B) CARRIER HEARING.—
‘‘(i) DEADLINE
FOR
DECISION.—A
carrier shall conduct and conclude a hear-
ing, and mail the notice of the decision, by
not later than the end of the 60-day period
beginning on the date a request for a car-
rier hearing has been timely filed.
‘‘(ii) OPTION TO PROCEED TO HEAR-
ING BY ADMINISTRATIVE LAW JUDGE.—No
carrier hearing shall be held, and no re-
quirement for a carrier hearing shall apply
with respect to rights to a hearing before
an administrative law judge, if the party to
the carrier review elects a hearing before
an administrative law judge in lieu of a
carrier hearing.
‘‘(C) HEARING BY ADMINISTRATIVE LAW
JUDGE.—