Are Beneficiaries Receiving Adequate Due Process?
Medicare Part D, the newly created prescription drug program for seniors, provides a multi-level appeals process: re-determination by the private drug plan, review by a Qualified Independent Contractor, an ALJ hearing, review by the Medicare Appeals Council, and judicial review. Although this framework looks quite comprehensive in its general outline, countless specific issues have arisen in its implementation, ranging from the adequacy of the notices of denial provided by private plans, through the opportunity, or not, for an in-person hearing before the Plans, to questions of deference to the opinion of an attending physician and the scope of review. This panel of experts will address the pitfalls of the appeals process, highlight current shortcomings and inconsistencies between the rules and the statute, and consider possible reforms. Panelists: Paul Cotton, Senior Legislative Representative on Health Issues and Federal Affairs, AARP, Washington, DC Anthony J. Culotta, Director, Med
