American Association for Clinical Chemistry
Better health through laboratory medicine
08/19/99

The Honorable William Thomas
U.S. House of Representatives
1136 LHOB
Washington, DC 20515


Dear Representative Thomas:

The American Association for Clinical Chemistry (AACC) endorses your legislation, H.R. 2356, the Medicare Patient Appeals Act of 1999, which would streamline and clarify the Medicare coverage appeals process. Specifically, H.R. 2356 establishes timelines at each stage of the coverage review process to ensure that beneficiaries, providers, technology manufacturers and others receive timely action on their appeals.

Earlier this year, the Health Industry Manufacturers Association (HIMA) testified before the Subcommittee on Health that, on average, it takes 119 days for a Part B carrier claim to go through the carrier review and fair hearing stages of the appeals process. They further stated that it takes, on average, 664 days to receive a decision from an administrative law judge (ALJ) once a hearing is requested. Thus, it regularly takes Medicare more than two years to decide a beneficiary's appeal, thereby possibly delaying patients access to new and innovative technologies. This timeframe needs to be reduced.

Another concern raised before panel was the need for an appeals mechanism for local coverage policy decisions. Currently, many carriers review and make appeals decisions on a claim by claim basis. Thus, even if an ALJ rules that a carrier must pay for an individual's treatment, that ruling only applies to that singular patient. Other patients denied coverage for the same treatment would still have to petition for carrier review and go through the entire lengthy process to gain coverage. This process is incoherent, unfair to beneficiaries and an inefficient use of carrier/government resources.

AACC is pleased that H.R. 2356 addresses these problems by setting deadlines for carrier, ALJ and Health and Department of Human Services review. This should significantly reduce the amount of time beneficiaries and manufacturers have to wait for a claims decision. Also, permitting beneficiaries and manufacturers to challenge the broad principles underlying a local policy should result in more uniform payment decisions and reduce beneficiary appeals. We believe H.R. 2356 is definitely a step in the right direction.

By way of background, AACC is the principal association of professional laboratory scientists--including MDs, PhDs and medical technologists. AACC's members develop and use chemical concepts, procedures, techniques and instrumentation in health-related investigations and work in hospitals, independent laboratories and the diagnostics industry nationwide. The AACC's objectives are to further the public interest and educational activities and to help maintain high professional standards.

If you have any questions or we may be of any assistance, please call me at (405) 271-3571 or Vince Stine, Director, Government Affairs, at (202) 835-8721.

Sincerely,

 

K. Michael Parker, PhD
President