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Michael J. Astrue, Commissioner of Social Security, today announced that the agency’s first Extended Service Team (EST) is open for business in Little Rock, Arkansas. The Little Rock EST will make disability decisions for state Disability Determinations Services (DDSs) that are most adversely affected by the flood of new initial disability claims resulting from the economic downturn and from counterproductive furloughs of employees at the state level. Later this year, Social Security will open additional ESTs in Madison, Mississippi; Roanoke, Virginia; and Oklahoma City, Oklahoma. The ESTs are in states that have a history of high quality and productivity, as well as the capacity to hire and train significant numbers of additional employees.

“The strategy behind ESTs builds on our success with National Hearing Centers, where cases are handled electronically from all over the country,” Commissioner Astrue said. “These centralized units have reduced the hearings backlog and improved processing times at some of the hardest-hit hearing offices. This approach clearly works and extending it in this way can help us meet the challenge of unprecedented growth in our disability workloads.”

Social Security expects to receive more than 3.3 million applications for disability benefits this fiscal year (FY), about 700,000 more than in FY 2008. In addition, more than a dozen states are furloughing federally-funded state workers who make disability decisions for Social Security. The combination of increased workloads and state furloughs has resulted in a growing backlog of initial disability applications in state DDSs.

“More Americans than ever are turning to us for help,” said Commissioner Astrue. “I am grateful that Governor Beebe bucked the trend and recognized the value of more of our federally-funded jobs in his state. The opening of the Arkansas EST and our other planned expansions in Mississippi, Virginia, and Oklahoma will significantly benefit disabled workers and their families as well as create new job opportunities to these states during difficult economic times.”

For more information about Social Security’s strategy to address the unprecedented increase in disability benefit applications, go to www.socialsecurity.gov/legislation/testimony_111909.htm.

Once an initial claim determination is made, beneficiaries, providers, and suppliers have the right to appeal Medicare coverage and payment decisions. There are five levels in the Medicare Part A and Part B appeals process. The levels are:

First Level of Appeal:    Redetermination by a Medicare carrier, fiscal intermediary (FI), or Medicare Administrative Contractor (MAC).

Second Level of Appeal: Reconsideration by a Qualified Independent Contractor (QIC)

Third Level of Appeal:   Hearing by an Administrative Law Judge (ALJ) in the Office of Medicare Hearings and Appeals

Fourth Level of Appeal: Review by the Medicare Appeals Council

Fifth Level of Appeal:    Judicial Review in Federal District Court

Expedited Determination Appeals Process (Some Part A claims only)

Home Health Agencies (HHAs), Skilled Nursing Facilities (SNFs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), and Hospices with beneficiaries enrolled in the original Medicare (fee-for-service) plan are required to notify beneficiaries of their right to an expedited review process when these providers anticipate that Medicare coverage of their services will end.

For more detailed information and timeframes about the Expedited Determination Appeals Process, go to the Expedited Determination Appeals Process page on the left.

For more detailed information about each level of appeal, go to the left side of this page or scroll down to the “Related Links Inside CMS” section. To see a diagram of the original Medicare (fee-for-service) standard and expedited appeals process, go to the “Downloads” section below. 

Source: http://www.cms.hhs.gov/OrgMedFFSAppeals/