Retrospective Appeal Requests (CMS-10885)

Eligible beneficiaries (as defined by the court order) may pursue an appeal under this proposed rule. The rule proposes a retrospective review process for certain beneficiaries to appeal denials of Part A coverage of hospital services (and certain skilled nursing facility (SNF) services, as applicable), for specified inpatient admissions involving status changes dating back to January 1, 2009, and which occurred prior to the implementation of the prospective appeal process. This collection effort will establish a model request for use by beneficiaries or their appointed or authorized representatives to assist them with filing a retrospective appeal. This is as required by the order from the Federal district court for the District of Connecticut in the case Alexander v. Azar, 613 F. Supp. 3d 559 (D. Conn. 2020)), aff’d sub nom., Barrows v. Becerra, 24 F.4th 116 (2d Cir. 2022).

The latest form for Retrospective Appeal Requests (CMS-10885) expires 2027-11-30 and is listed under ICR 202410-0938-017.