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NAHC Report: Issue# 2521, 10/6/2014
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Medicare Administrative Contractors to Increase Participation in ALJ Hearings
HHS OIG Reports on Access to Medicaid Managed Care
For Your Information: Book Your Hotel Room for NAHC’s Annual Meeting
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Medicare Administrative Contractors to Increase Participation in ALJ Hearings

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 8501 - Defending Medicare Review Decisions at Administrative Law judge (ALJ) Hearings. In the CR, CMS instructs the Medicare Administrative Contractors (MACs) to take a more active role in medical review appeals that reach the ALJ level and how they should coordinate with the Qualified Independent Contractor (QIC) to receive the notice of hearing. The MACs may be a participant or a party to an ALJ hearing as outlined in 42 CFR 405.1010 and 405.1012.      

If the contractor elects to participate or be a party to a hearing, it advises the ALJ, the appellant, and all other parties identified in the notice of hearing of its intent to participate no later than 10 calendar days after receiving the notice of hearing. Participation may include filing position papers or providing testimony to clarify factual or policy issues in a case, but it does not include calling witnesses or cross-examining the witnesses. As a party to the hearing, the contractor may file position papers, provide testimony to clarify factual or policy issues, call witnesses or cross-examine the witnesses of other parties.

The MACs must obtain approval from CMS prior to electing party status. In the event that CMS does not approve the MAC’s request for party status, the MAC may elect to proceed as a participant.   

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HHS OIG Reports on Access to Medicaid Managed Care

In September, the Department of Health and Human Services Office of Inspector General (HHS OIG) released a report titled State Standards for Access to Care in Medicaid Managed Care. This article discusses some of its major findings, and implications for home care agencies below.


The Report is the result of a congressional request for HHS OIG to look into access of care for Medicaid managed care enrollees. HHS OIG surveyed state Medicaid agency officials in the states that had “full risk” Medicaid managed care, in a total of 33 states. The Report defines “full risk” as an arrangement where “managed care organizations (MCOs) assume the full financial risk for delivering a comprehensive set of services.” HHS OIG also interviewed the Centers for Medicare & Medicaid Services (CMS), as well as external quality review organizations (EQROs).

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Book Your Hotel Room for NAHC’s Annual Meeting
Discount rates have expired but there are still rooms available at the regular rates

NAHC’s 2014 NAHC Annual Meeting & Exposition is being held in Phoenix, Arizona, at the Phoenix Convention Center. If you still need to make a hotel reservation, click here to be redirected to our third party housing partner. This site will research all conference hotels and hotels in greater Phoenix to provide you with options over your travel dates.

If you have an existing reservation through the NAHC Housing Center, you can still make updates to your reservations by clicking here through October 2, 2014. After that time, you will need to contact your hotel directly to modify your reservation.

If you made your hotel reservations directly with the hotel before July 30, 2014, and need to update or change your information, please click here.

Registered Nurses and Hospice Staff

Renown Health, based in Reno, Nevada, is looking for experienced, supportive Registered Nurses and hospice staff.

In keeping with our commitment to providing compassionate and continuum care at every stage of life, we are opening Renown’s first-ever hospice program and we're looking for experienced RNs and hospice staff with at least two years of prior hospice experience.

Renown Health is northern Nevada’s largest integrated health network and a nationally recognized healthcare leader. Based in Reno, Renown serves a 17-county region comprised of northern Nevada, Lake Tahoe and northeast California. The Reno-Tahoe region holds a range of lifestyle options that spans from downtown Reno to the shores of Lake Tahoe. With over 300 days of sunshine annually, it’s easy to understand why so many people choose to explore the natural beauty of our region. Experience as much or as little as you want as you thrive in our small-town feel and friendliness and all the financial benefits that come from a state with no state income tax.

Learn more at: or contact Anne Larson, Recruiter, at 775-982-6306. EEO/M/F/V/D


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