BIPA Fast-Track Appeals
Benefits Improvement and Protection Act (BIPA)

A Medicare regulation pertaining to the rights of patients enrolled in traditional, fee-for-service Medicare became effective July 1, 2005. Section 521 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), Pub.L.106-554, amended section 1869 of the Social Security Act (the Act) to require significant changes to the Medicare appeals procedures.

Under this new requirement, hospices, home health agencies, skilled nursing facilities and comprehensive outpatient rehabilitation facilities must deliver standardized notices to all beneficiaries no later than two days in advance of their discharges or termination of their services.

If a patient disagrees with the discharge from care after receiving the Notice of Medicare Provider Non-Coverage, he/she can request an immediate review from the Arkansas Foundation for Medical Care. Should a patient request an immediate review, AFMC will notify you that a beneficiary has requested an expedited determination, and you must send a detailed notice to the beneficiary by close of business of the day that we notify you.

For your convenience, AFMC has posted the criteria for each setting that will be used in these reviews. The Notice of Medicare Provider Non-Coverage and the “detailed notice” have also been posted.

• Case Review Criteria for Home Health Agency (HHA)
• Case Review Criteria for Hospice
• Case Review Criteria for Comprehensive Outpatient Rehabilitation Facility (CORF)
• Case Review Criteria For Skilled Nursing Facility (SNF)