NOTE: OMHA is in the process of drafting new OCPM chapters and revising existing OCPM chapters to reflect changes to the manual’s format and organization. We are also making updates to address changes made by the Medicare appeals final rule that became effective March 20, 2017 (82 Fed. Reg. 4974 (Jan. 17, 2017)). You will find new and revised chapters posted here as they become available. For prior versions, refer to the 2017 Case Processing Manual. Please note that chapter numbering may have changed.
Chapter 1
Chapter 2
Chapter Name |
Revision Updates |
Publish Date |
---|
Information Disclosure |
Initial Release |
6/17/2020 |
Chapter 2 Information Disclosure material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance. |
Chapter 3
Adjudicators, Authorities, Burdens, and Standards of Review
Chapter 4
Chapter Name |
Revision Updates |
Publish Date |
---|
Parties - 07122019 |
4.4.1.1: Revised citations to reflect CMS manual update with direct reference to UPICs |
7/12/2019 |
Parties |
Initial Release |
3/29/2019 |
Chapter 4 Parties material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance. |
Chapter 5
Chapter Name |
Revision Updates |
Publish Date |
---|
Representatives - 07122019 |
5.2.1.2: Revised required elements of an AOR in accordance with revised 42 C.F.R. section 405.910 and updates to chapter 29, section 270.1.2 of the Medicare Claims Processing Manual |
7/12/2019 |
Representatives |
Initial Release |
7/27/2018 |
Chapter 6
Chapter Name |
Revision Updates |
Publish Date |
---|
CMS, CMS Contractor, and Plan Roles - 07122019 |
6.3.4, 6.5.4.1, 6.5.10, 6.7.3.1, 6.7.3.3, 6.7.4: Revised to replace references to OMHA Program Evaluation and Policy Division with references to Appeals Policy and Operations Division; revised to identify recipients for contractor elections, requests, position papers, and written testimony in appeals escalated to OMHA; revised to clarify that an attorney adjudicator may also grant additional time for submissions; revised to clarify that CMS designated the AdQIC to receive notices of hearing |
7/12/2019 |
CMS, CMS Contractor, and Plan Roles - 05242019 |
6.3.1.1, 6.3.2: Revised citations to reflect CMS manual update with direct reference to UPICs |
5/24/2019 |
CMS, CMS Contractor, and Plan Roles |
Initial Release |
7/27/2018 |
Chapter 6 CMS, CMS Contractor, and Plan Roles material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance. |
Chapter 7
Chapter 8
Special Case Processing Procedures
Chapter 9
Chapter 10
Chapter 11
Chapter Name |
Revision Updates |
Publish Date |
---|
Procedural Review and Determinations - 07122019 |
11.3.4, 11.3.6.3: Revised to replace references to OMHA Program Evaluation and Policy Division with references to Appeals Policy and Operations Division; replace footnote citation to Federal Register with citation to revised 42 C.F.R. section 405.1006(d)(4) |
7/12/2019 |
Procedural Review and Determinations |
Initial Release |
5/24/2019 |
Chapter 11 Procedural Review and Determinations material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance. |
Chapter 12
Administrative Record and Exhibiting (See 2017 Case Processing Manual)
Chapter 13
Issues on Appeal and Case Development
Chapter 14
Chapter 15
Chapter 16
Chapter Name |
Revision Updates |
Publish Date |
---|
Decisions |
Initial Release |
10/09/2019 |
Chapter 16 Decisions material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance. |
Chapter 17
Chapter Name |
Revision Updates |
Publish Date |
---|
Dismissals - 07122019 |
17.1.5, 17.1.5.3, 17.2.2: Revised footnote citations to reflect relocation of Part D AIC provisions in 42 C.F.R. section 423.1970 to new section 423.2006 |
7/12/2019 |
Dismissals |
Initial Release |
11/30/2018 |
Chapter 18
Chapter Name |
Revision Updates |
Publish Date |
---|
Requests for Information and Remands - 07122019 |
18.1.1.2, 18.1.5, 18.1.7.2, 18.2.2, 18.4.3: Revised to clarify that a request for information may be made for an official copy of a dismissal of a request for redetermination or reconsideration, a remand may be issued if the requested information is not provided, and such a remand may be subject to review by the CALJ or designee; revised to replace references to OMHA Program Evaluation and Policy Division with references to Appeals Policy and Operations Division |
7/12/2019 |
Requests for Information and Remands |
Initial Release |
11/30/2018 |
Chapter 19
Chapter Name |
Revision Updates |
Publish Date |
---|
Closing the Case - 03292019 |
19.4.3, 19.5.1: Revised to clarify that if an adjudicator issues a consolidated decision, the adjudicator must also consolidate the record and combine the appeals in the case processing system |
3/29/2019 |
Closing the Case |
Initial Release |
5/25/2018 |
Chapter 19 Closing the Case material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance. |
Chapter 20
Chapter Name |
Revision Updates |
Publish Date |
---|
Post-Adjudication Actions - 07122019 |
20.5.5.2, 20.7.1.3, 20.7.1.4, 20.7.5.6, 20.7.7.3, 20.8.4, 20.8.5.6, 20.8.6.1, 20.8.7.2, 20.9.1, 20.9.5, 20.10.3, 20.11.4, 20.11.6: Revised to clarify that the re-established appeal number is used on an order vacating a remand; revised to clarify that requests for paper administrative records are made directly with Central Operations; revised to remove an incorrect statement that an ALJ must make a request for information before a remand for a missing case file is authorized under 42 C.F.R. section 405.1056(a)(2); revised time frame for vacating dismissals from 6 months to 180 calendar days in accordance with revised 42 C.F.R. sections 405.1052(e) and 423.2052(e); revised to replace references to OMHA Program Evaluation and Policy Division and Field Operations Division with references to Appeals Policy and Operations Division |
7/12/2019 |
Post-Adjudication Actions |
Initial Release |
5/25/2018 |