On October 13, 2017, HHS issued a transmittal change request to update Section 3.9 of the Medicare Program Integrity Manual (MPIM), stating that only one entity (CMS or a CMS contractor) may attend an ALJ hearing as a party, although additional entities may be non-party participants and may file position papers and/or written testimony or be called as a witness by CMS or a CMS contractor who is a party to the hearing. The ALJ also has discretion to grant leave for additional entities to attend the hearing.

The Transmittal and the changes to Section 3.9 of the MPIM follow HHS’s January 17, 2017 final rule revising the procedures that HHS follows at the ALJ level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries (Final Rule), set forth at 42 C.F.R. §§ 405.1010, 405.1012, and 423.2010.

Revised Section 3.9 of the MPIM, to take effect November 14, 2017, describes the contractors’ role in the ALJ hearing as a party, a participant, and as a witness for CMS or another CMS contractor that is a party to the hearing. The revised Section 3.9 also describes the process by which contractors will select cases for participation and decide their role (i.e., as a party, participant, or witness). It also describes the process for pre-hearing coordination if multiple entities are participating in a hearing.

The Transmittal is available here.