Summary
"OMHA is a responsive forum for fair, credible, and timely decision-making through an accomplished, innovative, and resilient workforce. Each employee makes a difference by contributing to shaping American healthcare."
OMHA nationally administers the third level of appeals for the Medicare program. The Associate Chief ALJs within OMHA issue the decision of the Secretary (except for decisions reviewed by the Medicare Appeals Council) on appeals involving Medicare Parts A, B, C, and D, entitlements and premium rate increases. OMHA provides the basic mechanisms through which individuals and organizations dissatisfied with Medicare determinations affecting their rights in the Medicare program may obtain a hearing under the Social Security Act on these determinations. The OMHA offices incorporate state of the art video-teleconferencing and audio-teleconferencing technologies, automated data reporting and case management systems, and a variety of other office automation and IT technologies to aide Associate Chief ALJs and their staff in the adjudication of Medicare appeals.
In conformity with the Administrative Procedures Act, 5 U.S.C. 551, et. seq. as well as the Medicare provisions of the Social Security Act and their attendant regulations, OMHA ALJs make pre-hearing rulings, preside over formal hearings, decide post-hearing matters, and issue written decisions under authority delegated by the Secretary of HHS. Issues on appeal arise from Medicare coverage and payment determinations made by Medicare contractors, Medicare Advantage Organizations (MAOs), or Part D Plan Sponsors (PDPSs), and determinations related to Medicare eligibility and entitlement, and income-related premium surcharges made by the Social Security Administration (SSA) under sections 1869, 1155, 1876(c)(5)(B), 1852(g)(5), and 1860D-4(h) of the Social Security Act. The appeals are frequently complex, require the interpretation and application of federal statutes, regulations, and program policy, may be contested, and are subject to demanding time constraints.