FOR IMMEDIATE RELEASE
Thursday, June 24, 1999CONTACT: Karen Alcorn
(202) 434-7240
Linda Ruckel
(202) 434-7243
MEDICAL DEVICE INDUSTRY APPLAUDS REPRESENTATIVE
THOMAS' EFFORTS ON MEDICARE APPEALSWASHINGTON, DC -- The Health Industry Manufacturers Association (HIMA) commends Representative William Thomas (R-CA), Chairman of the House Ways and Means Health Subcommittee, for his efforts to clarify and improve the appeals process for Medicare coverage decisions regarding life-saving, life-enhancing medical technologies. Thomas today introduced the "Medicare Appeals Act of 1999," designed to enhance the rights of Medicare patients in appealing decisions made by the Health Care Financing Administration (HCFA) and its local contractors.
"We appreciate Representative Thomas' leadership efforts to reform the Medicare coverage process," said Ron Dollens, chairman of HIMA's board. "This bill will make the appeals process clearer, more effective and timely, and alleviate several deficiencies that currently exist in the system. More importantly, it will allow Medicare beneficiaries to receive more timely access to much needed medical technologies."
Joining Thomas in introducing the bill was Pete Stark (D-CA). Stark serves as ranking democrat on Thomas' Ways and Means Health Subcommittee which has jurisdiction over Medicare coverage and coverage appeals.
Appeals decisions are a critical element of the overall Medicare coverage process because they help determine whether or not medical products will be available to Medicare beneficiaries. Critical among the bill's provisions is the creation of timeframes in which patients obtain a decision on their appeal. Under current law, HCFA and its contractors operate under practically no deadlines. On average, it takes 362 days—almost a year—for HCFA and its contractors to decide appeals of coverage and reimbursement decisions in the Medicare hospital program ("Part A"), and an average of 557 days—more than a year and a half—for the physician program ("Part B"). The time a senior spends waiting for an appeals decision is in addition to the time—often years—Medicare takes to make a coverage decision in the first place. The bill will help expedite patient access to advances in medical practice and technology by imposing timeframes for appeals. As a result, seniors will have cases heard in half the amount of time, putting decision timeframes more in line with those imposed by the Department of Labor on private sector health plans.
Another important provision establishes a new patient right to external review of national coverage determinations (NCDs) and makes additional improvements to the national appeals process allowing beneficiaries more opportunities to appeal decisions. Under current law, beneficiaries who disagree with a NCD have no recourse but to take the matter directly to court.
The bill establishes the Health and Human Services (HHS) Departmental Appeals Board, operating outside of the Health Care Financing Administration (HCFA) but within HHS, as the forum for an appeal of a NCD. Given the tremendous medical, scientific and regulatory complexity of NCD's, it is to the patient's advantage to have their case heard by a body with more appropriate expertise in Medicare policies than a court.
Finally, the bill creates a new local policy appeal to empower beneficiaries and other stakeholders to address and resolve claims involving the same product or procedure. Currently, thousands of patients must appeal these decisions on an individual claim-by-claim basis. Under this bill if a beneficiary prevails, that decision applies prospectively to future appeals by similarly affected beneficiaries in a local contractor area.
"We believe HCFA should want to be held accountable for the coverage decisions it makes," said Dave Fleming, chairman of HIMA's payment and health care delivery board committee. "This legislation is the first step in creating an effective appeals process to help ensure accountability."
The Medicare coverage appeals process and the opportunities for appealing decisions was the focus of a House Ways and Means Health Subcommittee hearing in April. "We commend Representative Thomas' commitment to follow through on the problems laid out at this hearing," said Fleming.
### The Health Industry Manufacturers Association (HIMA) is a Washington, D.C.-based trade association and the largest medical technology association in the world. HIMA represents more than 800 manufacturers of medical devices, diagnostic products, and medical information systems. HIMA's members manufacture nearly 90 percent of the $62 billion of health care technology products purchased annually in the United States, and more than 50 percent of the $147 billion purchased annually around the world.