CMS Adjusts Amount in Controversy Thresholds for Medicare Appeals

Today, the Centers for Medicare & Medicaid Services published a Notice in the Federal Register announcing the annual adjustment to the amount in controversy (AIC) threshold amounts for administrative law judge (ALJ) hearings and judicial review under the Medicare appeals process.

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) requires that the AIC threshold amounts for ALJ hearings and judicial review be adjusted annually.  In brief, the MMA requires that the AIC threshold amounts be adjusted by the percentage increase in the medical care component of the consumer price index (CPI) for all urban consumers for July 2003 to the July of the preceding year involved, and rounded to the nearest multiple of $10.

According to the Notice, the AIC threshold amount for ALJ hearings will increase to $120, and the AIC threshold amount for judicial review will increase to $1,180, for calendar year 2008.  These new amounts are based on the 18.2 percent increase in the medical care component of the CPI from July 2003 to July 2007. The adjustment to the AIC threshold amounts for calendar year 2008 will be effective for requests for ALJ hearings and judicial review filed on or after January 1, 2008.