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HHSOMAPD0004 - Appeal Level 1 - Procedures

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Agency Scheme:

HHSOMAPD0004

Level:

Appeal Level One

ADJUDICATION STRUCTURE

Appeals: Basic Structure

Appeal Office (local name):

Office of the Administrator

Appeal Office (global name):

Department of Health and Human Services: Office of the Administrator

Sub-Agency/Bureau/Division::

Centers for Medicare and Medicaid

Appeal Officer #1 (Title):

Appeals Officer

Are administrative appeals permitted from final decisions issued by this appellate office?:

No

PROCESS & PROCEDURE - General Information

Which party (or parties) is/are permitted to file appeals with this office?:

Private Party

Are private parties permitted to have representation at appeal hearings?:

Yes (All Types of Cases)

Who may serve as a private party representative?:

Either

Is the agency permitted to have representation at appeal hearings?:

N/A (e.g., Agency Not Party to Hearing)

Are ex parte contacts prohibited?:

No

Regulations/rules of practice for appeal hearings (please include CFR citations):

45 C.F.R. 147 et. seq.

PROCESS & PROCEDURE - Hearing Procedure

What types of hearings are permitted on appeals adjudicated by this office?:

In-Person

How is the type of hearing selected for appeals heard by this office?:

By Agency

Required by Rule

Depends on Nature of Case/Claim

How many appeal officers preside at each hearing?:

Three

Is factual development permitted at the appellate hearing as a means of supplementing the record from below?:

Yes (All Types of Cases)

Can third-parties submit amicus briefs and/or evidence?:

No

Are appeal hearings recorded and/or transcribed?:

Yes

Are appeal hearings open to the public?:

No (Hearings Always Closed/All Types of Cases)

If "Varies by Case," please describe:

Appeal hearings are closed during oral hearings.

PROCESS & PROCEDURE - Post-Hearing Procedure

Who typically drafts final decisions on appellate cases adjudicated by this office?:

Adjudication Officer

Who has authority to issue final decisions on appellate cases adjudicated by this office?:

Adjudication Officer

Do agency regulations or guidance provide time limits for issuance of final decisions on appellate cases?:

No

Is judicial review available after issuance of a final decision on appellate cases adjudicated by this office?:

Yes (All Types of Cases)

PROCESS & PROCEDURE - Case Management

Does the agency permit web-based electronic filing of briefs or other documents in cases adjudicated by this appellate office?:

Yes

Are final decisions issued by this appellate office published and/or posted on the agency website?:

Yes (Some Decisions)

If "Yes (Some Decisions)," how does the agency determine which final decisions to publish/post? Please briefly describe:

The Board publishes its decisions online.

Do agency regulations/rules of practice specify the contents of the administrative record on appeals heard by this office?:

No

Do agency regulations/rules of practice provide for closure of the record on appeals heard by this office?:

Yes (Some Types of Cases)

If "Yes," please provide citation(s):

45 C.F.R. 147 et. seq.

ADJUDICATORS

Total # of Appeal Officers:

12

Information About Appeal Officer:

Adjudication Officer Title	Job Series	Pay Plan	Pay Range	Are persons in this position employed full-time as adjudication officers?
Appeals Officer	0930-Hearings and Appeals Series	AA	01-06	Yes

ADR: General Information

Is ADR available at one or more points for appellate cases heard by this office?:

Yes

If "Yes," when is ADR available?:

Pre-Hearing

Post-Hearing

Is ADR a mandatory or voluntary process?:

Voluntary

What type(s) of ADR are available?:

Mediation

If "Other," please specify::

http://www.hhs.gov/dab/divisions/adr/index.html

ADR – Summary Statistics

For Fiscal Year 2013, please provide the following annual ADR statistics:

CASELOAD STATISTICS - Supplementary Statistics

Supplementary Caseload Statistics by Case Type:

Verified by Agency:

Not verified

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HHSOMAPD0004 - Appeal Level 1 - Procedures