On Friday, June 25, 2004, the Centers for Medicare & Medicaid Services ("CMS") proposed numerous changes to its regulations governing the appeals process for Medicare reimbursement determinations, which are typically heard by CMS's Provider Reimbursement Review Board ("PRRB"). See 69 Fed. Reg. 35,716. There are several noteworthy proposals that would dramatically affect the cost report filing and provider appeals processes. For example, the proposed rule purports to establish a requirement for providers to follow the applicable procedures for filing a cost report "under protest" in order to appeal traditional "self-disallowance" items (i.e., challenges to the validity of a statute, regulation, or other Medicare policy where the fiscal intermediary lacks the discretion to award the reimbursement sought by the provider). Additionally, the proposal seeks to significantly curtail a provider's ability to add new issues to a pending appeal before the PRRB by limiting the time frame for adding such issues. There are other proposals covering a variety of issues including, without limitation, the calculation of time periods for filing a hearing request, requests for good cause extensions to the time period for requesting a hearing, discovery procedures and timelines, PRRB decisions, and the reopening process. Comments to the proposed rule are due by no later than 5 p.m. on August 24, 2004.
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