HHS Renews Settlement Conference Facilitation for Appeal Resolutions
Monday, July 1, 2019
Posted by: Kyle Simon
Courtesy of the National Association for Home Care & Hospice
The Department of Health and Human Services (HHS) has renewed its Settlement Conference Facilitation (SCF) program. The SCF is available to all Medicare Part A and Part B providers and suppliers with appeals pending at the Administrative Law Judge (ALJ) or the Medicare Appeals Council (Council) level. The appeals must have been filed on or before March 31, 2019.
SCF is an alternative dispute resolution process designed to bring the appellant and the Centers for Medicare & Medicaid Services (CMS) together to discuss the potential of a mutually agreeable resolution for Medicare Part A and Part B claims. If a resolution is reached, a settlement document is drafted to reflect the agreement. As part of the agreement, the requests for hearing or review for the appeals covered by the settlement will be dismissed.
The SCF program began in 2014 and, over time, expanded the eligibility criteria and to appeals from additional provider types. In June 2018, the program was expanded to include appeals from all Medicare Part A and Part B providers and suppliers, which include home health and hospice. The last implementation phase of the program applied to appeals submitted to the ALJ and/or Council on or before November 2017.
A facilitator uses mediation principles to assist the appellant and CMS in working toward a mutually agreeable resolution. The facilitator does not make official determinations on the merits of the claims at issue and does not serve as a fact finder, but may help the appellant and CMS see the relative strengths and weaknesses of their positions. The facilitator is an employee of the Office of Medicare Hearings and Appeals, which is a component of the HHS Office of the Secretary, and is organizationally and functionally separate from CMS. Mediation within this program is centered on facilitating payment negotiations.
In light of the continued backlog of appeals at the ALJ and Council levels, the National Association for Home Care & Hospice encourages home health and hospice agencies to consider the SCF process to resolve any eligible pending appeals.
SCF eligibility criteria and details of the SCF process can be found here.