On June 16, 2021, the Provider Reimbursement Review Board (PRRB) issued proposed changes to its rules and an order requiring all submissions for new and/or pending appeals to be filed electronically using the Office of Hearings Case and Document Management System (OH CDMS) beginning November 1, 2021. The Board will no longer accept documents submitted by paper barring exceptional circumstances. Stakeholders have until July 30, 2021 to comment on the proposed changes.
OH CDMS is an online portal that providers and their counsel can use to make electronic submissions to the PRRB—from initiating appeals to filing position papers. Use of OH CDMS has been strictly optional since it went live in August 2018. The PRRB has continued to accept paper filings.
In the IPPS rule for FY 2021, CMS observed that OH CDMS has over 800 registered users, and over 75 percent of appeals have been filed electronically since it launched. On that basis, CMS amended its regulations to authorize the PRRB to mandate electronic filing as early as FY 2021, provided that stakeholders were given 120-days’ notice of the transition, and the PRRB updated its instructions to reflect the mandate. Acting on that authority, the PRRB ordered last week that “all submissions to the Board for new or pending appeals (e.g., appeal requests, correspondence, position papers) must be filed electronically” using OH CDMS starting on November 1, 2021, “unless the Board grants an exception.”
The PRRB has also proposed to update its rules to implement the transition to mandatory electronic filing. The proposed rules describe two narrow circumstances in which the PRRB will accept filings not made via OH CDMS. First, the PRRB will entertain exceptions if a disability would prevent or materially hinder electronic filing, provided that the party seeking the exception contacts the PRRB ten days in advance of the deadline. Second, a party can request an exception due to extraordinary circumstances. The request can be submitted in paper, and “[e]xcept for cases of impossibility,” must be filed within ten days of the deadline.
The PRRB’s proposed rules also address situations in which parties who miss filing deadlines due to technical difficulties with OH CDMS can request an extension. For PRRB-set deadlines (not appeals), the proposed rules state that the PRRB will entertain requests for extensions if the requests are submitted electronically within 24 hours after the technical difficulties are resolved. The request must describe the technical issue, specify when it was identified, the party’s efforts to resolve the issue, and include the OH CDMS Help Desk ticket number and the communication from the Help Desk indicating that the issue has been resolved. The request must also confirm whether there are any other registered users in the party’s organization and if so, why those users could not make the filing. For appeal deadlines, the proposed rules specify that the PRRB will only grant extensions (due to technical difficulties with OH CDMS or otherwise) if the provider was prevented from filing a timely appeal due to “extraordinary circumstances beyond its control.”
The updated rules also contain new instructions for filing schedules of providers for group appeals. If a group is fully formed, and all its participants are populated in OH CDMS, the representative will not be required to submit a paper schedule of providers. Alternatively, if any participants in a fully formed group are not populated on OH CDMS, the representative will have to submit a paper schedule of providers for all participants in the group within sixty days of informing the PRRB that the group is complete. Additionally, representatives will be required to submit a full schedule of providers if requesting expedited judicial review for a fully formed group if any of the participants are not populated in OH CDMS.
A copy of the PRRB’s order and proposed changes to its rules is available here.
