Chapter 29 Updates

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Chapter 29 Updates

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Subject: Pub. 100-04, Chapter 29 – Appeals of Claims Decisions – Revision

Full Transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4278CP.pdf

Number: 4278

Title: 11042

Summary: This Change Request (CR) updates Pub. 100-04, Chapter 29 with several policy updates, including electronic signatures, limiting scope of redetermination review in certain instances, application of good cause for late filing involving beneficiary accessibility, as well as application of good cause where there is a declared disaster. As more Medicare Administrative Contractors (MACs) are brought on board to the Medicare Appeals System (MAS), instruction is being added related to MAS processing functions. In addition, the requirement for both signatures on an appointment of representative instrument and the Assignment of Appeal Rights form to be made within 30 days of each other is being removed. There are also minor grammar or formatting corrections made throughout the chapter. Changes in the appeals regulations at 405 subpart I are incorporated, which include tolling an adjudication timeframe when trying to cure a defective appointment form, as well as changes relative to the third level of appeals handled by the Office of Medicare Hearings and Appeals (OMHA).

Release Date: April 12, 2019

Effective Date: June 13, 2019

Implementation Date: June 13, 2019

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