[Federal Register: June 23, 2005 (Volume 70, Number 120)]
[Notices]
[Page 36386-36387]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr23jn05-50]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Office of Medicare Hearings and Appeals; Statement of
Organization, Functions, and Delegations of Authority
Part A. Office of the Secretary, of the Statement of Organization,
Functions, and Delegations of Authority for the Department of Health
and Human Services, Part A, as last amended at 69 FR 51679-51680, dated
August 20, 2004, and Chapter AA, Immediate Office of the Secretary, as
last amended at 69 FR 51679-51680, dated August 20, 2004, are being
amended to establish a new Chapter AK, the Office of Medicare Hearings
and Appeals (OMHA) within the Office of the Secretary. This new Chapter
is being created as a result of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA), under which the
functions of Administrative Law Judges (ALJs) responsible for hearing
cases under title XVIII of the Social Security Act (and related
provisions in title XI of such Act) are transferred from the Social
Security Administration to the Department of Health and Human Services.
The changes are as follows:
I. Under Part A, Chapter AA, Section AA, Section AA.10
Organization, insert the following: ``Office of Medicare Hearings and
Appeals (OMHA)''
[[Page 36387]]
II. Under Part A, establish a new Chapter AK, ``Office of Medicare
Hearings and Appeals (OMHA)'' to read as follows:
Section AK.00 Mission
Section AK.10 Organization
Section AK.20 Functions
Section AK.00 Mission. The Office of Medicare Hearings and Appeals
(OMHA), under direct delegation from the Secretary of the Department of
Health and Human Services, administers the nationwide hearings and
appeals programs for the Medicare Program. The ALJs within the Office
of Medicare Hearings and Appeals issue the final decisions of the
Secretary, except for decisions reviewed by the Medicare Appeals
Council, on hihgly complex appealed determinations involving Medicare
Part A, B, C, and D. OMHA provides the basic mechanisms through which
individuals and organizations dissatisfied with Medicare determinations
affecting their rights in the Medicare program under the Social
Security Act may obtain a hearing on these determinations. OMHA directs
four field offices staff with Administrative Law Judges (ALJs) who
conduct impartial ``de novo'' hearings and made decisions on appealed
determinations involving Medicare appeals, as well as a Headquarters
office.
Section AK.10 Organization: The Office of Medicare Hearings and
Appeals (OMHA) is under the direction of the Chief Administrative Law
Judge, who reports directly to the Secretary, OMHA consists of the
following components.
Office of Medicare Hearings and Appeals, Immediate Office
(AKA) Medicare Hearing and Appeals Field Offices (AKB1-4).
Medicare Hearing and Appeals Field Offices (AKB1-4).
--Medicare Hearings and Appeals Mid-Atlantic Field Office--Rosslyn,
VA (AKB1)
--Medicare Hearings and Appeals Mid-West Field Office--Cleveland,
OH (AKB2)
--Medicare Hearings and Appeals Western Field Office--Irvine, CA
(AKB3)
--Medicare Hearings and Appeals Southern Field Office--Miami, FL
(AKB4)
Section AK.20 Functions
A. The Office of Medicare Hearings and Appeals Immediate Office
(AK): The Office of Medicare Hearings and Appeals Immediate Office
(OMHA/IO) is headed by the Chief Administrative Law Judge (CALJ), who
reports directly to the Secretary. The Chief Administrative Law Judge
(CALJ) is responsible for carrying out OMHA's mission and implementing
authorities granted to the ALJs by the Secretary. The CALJ is
responsible for: (a) planning, directing, managing, coordinating, and
maintaining the integrity of the field office hearings and appeals
system by directing the planning, development, and coordination of
regulations, policies and procedures governing the hearings and appeals
program under the applicable statutes; (b) maintaining a hearings and
appeal system which is impartial and which supports the tenets of
fairness and equal treatment under the law; and (c) ensuring adherence
to statutory procedures, time limits, and other procedural requirements
of the Administrative Procedure Act, Medicare law and applicable HHS
regulations. The CALJ provides executive leadership to, and
administrative and management support functions for, the field offices
which hold hearings and render decisions under the Social Security Act,
and in that capacity establishes specific objectives, standards, and
management and program policies with respect to the field office
responsibilities.
The Executive Director (ED) of OMHA/IO, reports to the CALJ, and is
responsible for all operational matters and executive and managerial
oversight in support of the mission of the office, with the exception
of areas directly involving the conduct of adjudicatory hearings and
the rendering of fair and impartial decisions ensuing from those
hearings.
B. Medicare Hearings and Appeals Field Offices (AB1-4). The Field
Offices are headed by a Managing Administrative Law Judge (MALJ) who
reports directly to the CALJ. The Managing Administrative Law Judge
(MALJ) acts on behalf of the CALJ at the respective field office
location on all matters involving the hearing process, and is directly
responsible for the effective execution of the hearings process within
the field location. The MALJ is responsible for: (a) Providing
direction, leadership, management and guidance to the field office
staff, including Administrative Law Judges and their staffs, and
weighted workload attorneys; (b) field office implementation of
policies, goals, objectives, and procedures pertaining to the hearings
process, and formulating policies, goals, and objectives for the ALJs
and support staff in their field office; (c) planning, organizing and
administering field operations for scheduling and conducting
independent and impartial hearings on appealed determinations involving
adjudicatory hearings for authorities delegated to the ALJs by the
Secretary; (d) developing and recommending OMHA action with respect to
allegation of unfair hearings within the field operations; (e) upon
request by ALJs providing advice and guidance in matters related to
adjudicating cases under the provisions of the Social Security Act; and
(f) conducting adjudicatory hearings under authorities delegated to the
ALJs by the Secretary.
The Hearing Office Manager (HOM), who reports to the Managing
Administrative Law Judge (MALJ), is responsible for the day-to-day
management and operations of the field office, with the exception of
areas directly involving the conduct of adjudicatory hearings and the
rending of fair and impartial decisions ensuing from those hearings.
The Hearing Office Manager is responsible for: (a) Office management,
including workload, personnel, and overall resource management; (b)
executing and making critical evaluations and necessary revisions of
applicable field office objectives, policies, practices, and
procedures; (c) reviewing hearing practices and procedures to detect
trends, training needs, and operational problems; (d) justifying the
financial requirements needed to carry out the hearings in the field
office; and (e) coordinating operation and administrative activities
with OMHA/IO.
Supervisory Administrative Law Judges within the Field Offices are
responsible for conducting adjudicatory hearing for authorities granted
to the ALJs by the Secretary. Supervisory Administrative Law Judges are
also responsible for supervising staff attorney(s), paralegal(s), and
hearing clerk(s).
Attorneys and Paralegals are responsible for researching appeals;
reviewing and evaluating case files; preparing briefs and transcripts;
assisting in pre-hearing proceedings; drafting decisions; and,
providing assistance to Administrative Law Judges.
Hearing Clerks are responsible for assisting in the hearings and
appeals process. Administrative support staff, under direction of the
Hearing Office Manager, provide support services to hearings operations
staff, and the ALJs.
Dated: June 15, 2005.
Michael O. Leavitt,
Secretary.
[FR Doc. 05-12468 Filed 6-22-05; 8:45 am]
BILLING CODE 4140-04-M