Current Alerts

ALERT 22: UPDATE – Mandatory Electronic Filing & Revised PRRB Rules, Effective November 1, 2021 (September 30, 2021)

On June 16, 2021, the Provider Reimbursement Review Board (“Board”) provided 120 days’ advance notice that it is adopting mandatory electronic filing effective November 1, 2021.  In addition, the Board published revisions to Board Rules, effective November 1, 2021, and invited comments and other feedback from all interested parties on the revised Board Rules by Friday, July 30, 2021. Finally, the Board noted that: (1) it would review and consider all feedback but would not specifically respond to the feedback; and (2) based on its review of the comments, the Board might, as appropriate, further revise the Board Rules and, if so, would publish such revisions by Friday, October 1, 2021.

The Board appreciates the comments, suggestions, and other feedback it received from interested parties relating to both the Board Rules as well as OH CDMS.  Based on its review of that feedback, the Board has decided to further revise the Board Rules to either correct certain identified errors or clarify the revisions to the Board Rules published on June 16, 2021.  These additional revisions relate to Board Rules 4.4.3, 4.6.2, 5.4, 6.6, 7.3.2 - 7.4, 9, 20, 25, 25.3.1, 27.1, 28, 30.3.4, 31.1, 42.1, and 44.4.1 - 44.6.

The revisions to the Board Rules are effective November 1, 2021 and supersede all previous rules and instructions. Further, the Board reminds all parties appearing before the Board that mandatory electronic filing remains effective November 1, 2021.  The revised Board Rules and related Board Order are located at https://www.cms.gov/Regulations-and-Guidance/Review-Boards/PRRBReview/PRRB-Instructions.

 


ALERT 21: Mandatory Electronic Filing & Revised PRRB Rules, Effective November 1, 2021 and Change of Address, Effective Immediately (June 16, 2021)

The Provider Reimbursement Review Board (“Board”) has made revisions to the Board Rules, which are effective November 1, 2021 and supersede all previous rules and instructions. The Board Order adopting mandatory electronic filing and the revised Board Rules implementing this mandate as well as other revisions are located at https://www.cms.gov/Regulations-and-Guidance/Review-Boards/PRRBReview/PRRB-Instructions.

In updating the Board Rules to implement mandatory electronic filing, the Board made certain substantive changes as well as formatting, clarifications, and other non-substantive changes. The highlights of these updates include, but are not limited to:

  • Updates the Provider Reimbursement Review Board filing rules, making electronic filing using the Office of Hearings Case and Document Management System (“OH CDMS”) mandatory, unless an exemption applies.

  • Eliminates filing of Schedules of Providers (“SoP”) for group cases fully populated in OH CDMS.  NOTE: For cases not fully populated in OH CMDS, the SoP must be filed electronically in OH CMDS and, in certain specific situations, a hard copy of the SoP must also be filed (e.g., when a request for expedited judicial review is filed, a hard copy of the SoP must be filed in addition to the concurrent or prior electronic filing of the SoP).

  • Updates case representatives’ responsibilities to include familiarizing themselves with OH CDMS, as the required Board filing system and Board rules and procedures.

  • Allows for the issuance of Board Orders, in lieu of Board Alerts, as an extension of the Board Rules.

  • Requires providers to include information on parent owner or organization with an appeal request (as required by the regulation 42 C.F.R. §§ 405.1835(b)(4), (d)(4)).

  • Updates the Board’s address to the following new mailstop because the Board is moving to a new permanent home, effective immediately:

Provider Reimbursement Review Board
CMS Office of Hearings
7500 Security Boulevard
Mail Stop: B1-01-31
Baltimore, MD 21244-1850.

  • Updates rules for substantive claim challenges (relating to cost reporting periods beginning on or after 1/1/2016) and responses to said challenges pursuant to 42 C.F.R. § 412.24(j) and 42 C.F.R. § 405.1873(a).

  • Updates the requirements for requests to postpone a hearing.

  • Removes the blanket requirement to file 6 courtesy hard copies of briefs and exhibits 10 days prior to a scheduled Board hearing.

  • Officially adds video conferencing and video hearings as options for pre-hearing status calls and for actual hearings.

  • Sets a deadline for the Medicare Contractor to file responses to requests for Expedited Judicial Review (“EJR”).

As explained in the Board Order, the Board is inviting comments, suggestions, and other feedback on the revised Rules from all interested individuals, providers, government contractors, and other organizations. To ensure that your feedback is considered, we ask that you submit it via email only to PRRB@cms.hhs.gov by Friday, July 30, 2021. Please reference Alert 21 in the subject line of the email and describe in the email your nexus to the appeals process (e.g., provider, provider representative, consultant, or Medicare administrative contractor).

Please note that the Board will review and consider all feedback but will not specifically respond to the feedback. Accordingly, based on its review of the comments, the Board may, as appropriate, further revise the Board Rules and, if so, will publish such revisions by Friday, October 1, 2021. The Board looks forward to receiving your feedback.

 


ALERT 20: Change of Mailing Address

Superseded  See Alert 21

 


ALERT 19: Temporary COVID-19 Adjustments to PRRB Processes (March 25, 2020)

In keeping with guidance issued by the Office of Management and Budget (“OMB”), and public health precautions recommended in response to the COVID-19 virus, the Provider Reimbursement Review Board (“PRRB” or “Board”) and Centers for Medicare & Medicaid Services (“CMS”) support staff have temporarily adjusted their operations and are maximizing telework for the near future.  The Board is an independent panel created to adjudicate Medicare Part A payment disputes of institutional Providers arising from final determinations.  42 U.S.C. § 1395oo.  The Board recognizes that the immediate focus and priorities of Providers should be on caring for their patients.  Likewise, the Board wants to ensure the health and safety of all relevant parties before the Board, while continuing to operate in the most efficient manner possible.  Accordingly, the Board is issuing this Alert to provide information on processes affected by the temporary change in its operations.  In light of the developing circumstances surrounding COVID-19, the Board plans to continuously reassess its response and will issue additional updates through Board Alerts, as necessary.

The Board would like to remind parties that its electronic filing system known as the Office of Hearings Case and Document Management System (“OH CDMS”) remains fully operational and parties can use the system to make same-day filings.  OH CDMS is a web-based portal where Providers can file appeals and all parties can manage their cases.  Besides instantaneously accepting submissions electronically, OH CDMS releases outgoing electronic correspondence and Board decisions as well.  Use of OH CDMS is voluntary and it enables Providers and their representatives to manage their cases in real time and view all documents officially filed through the system (including viewing opposing parties’ submissions).

1.  How to make filings with the Board.

  • Electronic Filings.The Board encourages Providers to file and correspond with the Board electronically using OH CDMS.  If you have not signed up to use OH CDMS, please visit the PRRB Electronic Filing webpage at https://www.cms.gov/Regulations-and-Guidance/Review-Boards/PRRBReview/Electronic-Filing or contact the Board via email at PRRB@cms.hhs.gov for more information.

  • Hard Copy filings.The Board and CMS support staff are currently maximizing telework in response to the March 17, 2020 OMB Directive (M-20-16), and are not on site.  Therefore, if you make hard copy filings with the Board during the pendency of the Board’s temporary change in operations, Board action on that filing will be delayed until after normal operations resume.  Below are the instructions for making hard copy filings:

  • Mail/Third Party Carriers.The Board directs Providers to continue sending all mail to the Board (whether sent by USPS, FedEx or UPS) using the Board’s official address at 1508 Woodlawn Drive, Suite 100, Baltimore, MD 21207, as all mail is being forwarded to the Board’s current location (see Board Alert 18).  Again, please note that the Board’s processing of this mail will be delayed.

  • Hand Deliveries.The Board has temporarily suspended hand deliveries.

  • Delayed or Undelivered Correspondence to the Board.Consistent with Board practice, if Providers experience any delayed or undelivered correspondence to the Board (e.g., returned mail), the Board directs them to refile the correspondence and documents and explain those issues in the refiling.  For example, if a filing was returned as undeliverable, explain what transpired in the cover letter attached to the refiling and include a copy of the returned mail with the refiling.

2.  Suspension of “Board-Set Deadlines” from Friday, March 13, 2020 Forward.

The Board has set deadlines to make certain filings in existing appeals including, but not limited to, deadlines for filing preliminary or final position papers, Schedules of Providers, witness lists, and case status reports (hereinafter “Board-Set Deadlines”).  The Board encourages Providers and their representatives to continue to make these filings electronically through OH CDMS, as appropriate and in keeping with public health precautions.  However, as the use of OH CDMS is not yet mandatory, the Board is suspending “Board-Set Deadlines” from Friday, March 13, 2020 forward until the Board is back to normal operations (see 42 C.F.R. § 405.1801(d)).  Once the Board is in position to resume its normal operations, the Board will reassess the public health situation and post an alert for further guidance on the deadlines for these suspended filings.

Note:  Board-Set Deadlines” does not include the deadlines for filing of appeals or adding issues to appeals or any other deadlines established by statute or CMS regulations.  Pursuant to 42 C.F.R. § 405.1836, a Provider may submit a written request to the Board to extend the time for filing an appeal period for ‘‘good cause’’ where the Provider can establish that it could not reasonably have been expected to submit a hearing request within 180 days due to extraordinary circumstances beyond its control.

 

3.  Processing Requests for Expedited Judicial Review (“EJR”).

Whenever possible, the Board plans to continue processing EJR requests received in OH-CDMS within 30 days.  However, during the pendency of the Board’s temporary change in operations, the Board will not be able to receive and process EJR-related hard copy filings such as Schedules of Providers in the usual manner.  This impediment affects the Board’s ability to determine whether “a provider of services may obtain a hearing under” the PRRB statute, which is a necessary jurisdictional prerequisite for a Provider to be able to request EJR.  42 U.S.C. § 1395oo(f); see also 42 C.F.R. § 405.1842(b).  Accordingly, the Board will follow CMS regulations at 42 C.F.R. § 405.1801(d)(2) when calculating the Board’s 30-day time period by excluding all days where the Board is not able to conduct its business in the usual manner. 

4.  Postponing and Rescheduling April and May 2020 Hearings.

The Board will postpone and reschedule any in-person or telephonic hearing currently scheduled in April and May if the parties have been unable to reach administrative resolution.  The Board Advisor handling your case will be in contact with the parties to obtain a status update and to reschedule, as appropriate.  If the parties would like to proceed with a hearing currently scheduled in April or May, please contact your Board Advisor as soon as possible to discuss options.  In light of the developing circumstances, the Board is exploring its options for conducting hearings moving forward.

 


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Page Last Modified:
12/01/2021 08:00 PM