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 Dr., 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.
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.
ALERT 18: Temporary Relocation of the PRRB (September 25, 2019)
The Provider Reimbursement Review Board (“Board”) has temporarily relocated to CMS’ main complex because of a building emergency. Due to the emergency, the Board may not have access to hard copy/paper files for an unknown time. The Board is issuing this Alert to provide information on processes affected by the temporary relocation. The Board will provide additional instruction if necessary.
1. Filings and Correspondence with the Board:
OH CDMS.—The Board’s new electronic filing system known as the Office of Hearings Case and Document Management System (“OH CDMS”) is fully operational and same day filings may be made with OH CDMS. The Board encourages Providers to file and correspond with the Board using OH CDMS. If you have not signed up to use OH CDMS please contact the OH CDMS Help Desk at 833-783-8255 or your Board Advisor for more information.
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 Dr., Suite 100, Baltimore, MD 21207 as all mail is being forwarded to the Board’s temporary location.
Hand Deliveries.—The Board hereby modifies Board Rule 3.3.2 as follows. To ensure that someone will be available to receive a hand delivery for the Board during the weekday hours of 8 am to 4 pm, Providers must call and email 24 hours in advance to the Board to request instructions on where and how to make any filings by hand delivery. Specifically, at least 24 hours prior to each hand delivery, Providers must call 410-786-2671 and send an email to PRRB@cms.hhs.gov to request instruction on where and how to make each filing by hand delivery.
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 document 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. Hearings.—The Board is setting up alternative temporary hearing facilities in the Baltimore area. If you have a hearing coming up, the Board Advisor handling your case will be in contact with the parties to ensure the parties receive instructions on where the hearing will be held.
3. Hard Copy Files.—If your appeal and related filings were made in hard copy, the Board may not have access to that hard copy case file (in part or in whole) for the immediate future. To that end, Board action on your case may be delayed or the Board may request that the parties submit additional copies of filings previously made as needed and appropriate.
ALERT 17: Board Review of Rules and Procedure for PRRB Proceedings; Request for Comments, Suggestions, and Other Feedback (March 18, 2019)
The Provider Reimbursement Review Board (“Board”) is in the process of reviewing its rules and procedure for Board proceedings established under the authority of 42 U.S.C. § 1395oo(e) and 42 C.F.R. § 405.1868(a) (hereinafter “Board Rules”). The current Board Rules are posted on the Board’s website at /Regulations-and-Guidance/Review-Boards/PRRBReview/PRRB-Instructions. In particular, the Board is reviewing its Rules for the following areas:
Continued implementation of the new Office of Hearings Case and Document Management System (“OH CDMS”) as it relates to Board proceedings, including electronic filings in Board proceedings and the electronic issuance of all Board correspondence. In particular, we are interested in user feedback and experience on using OH CDMS for Board proceedings and how Board processes and OH CDMS can be better aligned.
Continued implementation of the final rule published on November 13, 2015 making certain revisions to the Board’s governing regulations at 42 C.F.R. Part 405, Subpart R. See 80 Fed. Reg. 70298, 70551-70580, 70597-70604 (Nov. 13, 2015).
Board Rules to facilitate Provider withdrawal of Board appeals to pursue resolution through reopening of the related NPR/RNPR. See Board Rules 46, 47.2.2, 47.2.3.
Board Rules related to group appeals including, but not limited to, the Schedule of Providers and supporting documentation discussed at Board Rules 20 to 22. See Board Rules 12-22.
Board Rules related to requests for expedited judicial review (“EJR”). See Board Rule 42.
To facilitate this review, the Board is inviting comments, suggestions, and other feedback on its Rules from all interested individuals, providers, government contractors, and other organizations. Please note that the Board will review and consider all feedback but will not specifically respond to the feedback. To ensure that your feedback is considered as part of the Board’s current review, we ask that you submit it via email only to PRRB@cms.hhs.gov by May 1, 2019. Please reference Alert 17 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). The Board looks forward to receiving your feedback.
ALERT 16: Re-issuance of Case Acknowledgement and Critical Dues Dates Notices, Requests for Information, and Notices of Hearing (September 4, 2018)
The PRRB will be re-issuing certain documents for open cases that were not filed through the Office of Hearings Case and Document Management System ("OH CDMS") in order to identify pending due dates and establish responsive case actions in the new electronic system. (See PRRB External User Manual, section 188.8.131.52.) Please be aware that you could receive another Case Acknowledgement and Critical Due Dates Notice, a Request for Information, or another Notice of Hearing for your case over the next several weeks, but note that the critical due dates for your case have not changed.
Please contact the Help Desk at 1-833-783-8255 or Helpdesk_OHCDMS@cms.hhs.gov if you notice any problems. Thank you for your flexibility as we continue to transition to OH CDMS.
ALERT 15: Revised PRRB Rules (August 29, 2018)
The Board has made revisions to the PRRB Rules, which are effective August 29, 2018 and supersede all previous rules and instructions. See /Regulations-and-Guidance/Review-Boards/PRRBReview/PRRB-Instructions.
The Board’s goal is to facilitate early resolution of appeals and eliminate unnecessary filing burdens where appropriate. The highlights of the rule updates include, but are not limited to:
Introduce the Office of Hearings Case and Document Management System (“OH CDMS”) and implement its use into the rules;
Require the transfer of issues from individual appeals to a common issue related party group (CIRP) appeals (if applicable) prior to the submission of the preliminary position paper or proposed joint scheduling order in order to comply with the related party regulations and narrow the issues briefed in the position papers;
Require the filing of the full preliminary position paper to both the opposing party and the Board (currently the preliminary position paper is only filed on the opposing party with only a cover letter to the Board);
Eliminate the requirement for a final position paper, making its submission optional and used to narrow the issues prior to hearing (applicable only for new appeals filed after the issuance of the rules);
Eliminate the requirement of the post hearing brief, making its submission optional and subject to the Board’s request
Provide an additional reinstatement option, where providers can file an appeal to protect their appeal rights, but withdraw it immediately to handle through a reopening with the MAC. Those cases, if not resolved by the parties, would have the option of being reinstated by the Board.
ALERT 14: Electronic Filing is Available through OH CDMS (August 16, 2018)
The PRRB module of the Office of Hearings Case and Document Management System (“OH CDMS”) is available for use. Users may access OH CDMS to file new appeals and all supporting documentation electronically and to review and maintain existing cases that are currently in an open status. The PRRB notices and decisions will be issued via email and will also be accessible through OH CDMS.
The PRRB Electronic Filing webpage at /Regulations-and-Guidance/Review-Boards/PRRBReview/Electronic-Filing will soon be updated with a user manual and frequently asked questions. The PRRB will also be issuing a new set of Board Rules in conjunction with the implementation of OH CDMS as well as to update other processes and procedures.
If you have not yet registered for the system, we encourage you to begin that process. For any system or registration questions, please contact the OH CDMS Help Desk at 1-833-783-8255 or Helpdesk_OHCDMS@cms.hhs.gov.
ALERT 13: Pre-Registration for PRRB Electronic Filing (August 2, 2018)
The PRRB module of the Office of Hearings Case and Document Management System (“OH CDMS”) will soon be available for electronic filing; however, parties may begin pre-registering for access to the system prior to its release. Please reference /Regulations-and-Guidance/Review-Boards/PRRBReview/Electronic-Filing for system updates, registration instructions, and frequently asked questions.
We would also like to offer several points of clarification:
OH CDMS registration is for the system as a whole, so if you have already registered in response to the MGCRB alert, you do not need to separately register for the PRRB module.
OH CDMS is designed that you may only have access to the system through one organization. You must register under the organization you work for, not for the provider(s) for which you intend to file a PRRB appeal or MGCRB application as multiple requests must be denied. For example, if you are at a parent level and oversee multiple providers within your corporate organization, then you should select the parent organization at registration.
The designated representative of a case has full access to view and take action on that case. The designated representative may be selected from a provider, parent, or representative organization.
For any system questions, please contact the OH CDMS Help Desk at 1-833-783-8255 or Helpdesk_OHCDMS@cms.hhs.gov.
All prior alerts are available by download below.