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Background

What The Board Does:

The Departmental Appeals Board (DAB) provides impartial, independent review of disputed decisions in a wide range of Department programs under more than 60 statutory provisions. The DAB generally issues the final decision for the Department, which may then be appealed to federal court. The DAB may issue a recommended decision for action by another official. The DAB has three broad areas of jurisdiction each with its own set of judges and staff. The DAB also has a leadership role in implementing Alternative Dispute Resolution (ADR) across the Department since the DAB Chair is the designated Dispute Resolution Specialist under the Administrative Dispute Resolution Act of 1996. DAB staff include trained mediators and facilitators. The DAB's ADR responsibilities include providing ADR services and training and coordinating and facilitating negotiated rulemaking committees.

The DAB resolves disputes with outside parties such as state agencies, Head Start grantees, universities, nursing homes, doctors, and Medicare beneficiaries. In a single year, disputes heard by the DAB may involve as much as $1 billion in federal grant funds.

Board Personnel:

The DAB has over 70 staff, including the Chair and four other Members of the DAB (Board), eight Administrative Law Judges (ALJs) (including the Chief ALJ), four Administrative Appeals Judges (AAJs) (Medicare Appeals Council), and the attorneys, paralegals, program analysts, and clerical staff who support the judges and provide ADR services.

History:

The DAB was chartered in 1973; until the 1980's, DAB jurisdiction was limited to disputes arising under the large public assistance grants, such as Medicaid and Aid to Families with Dependent Children, as well as discretionary grant programs. The Administrative Conference of the United States cited the DAB as a model administrative dispute resolution body. DAB's jurisdiction has gradually increased. In 1988, the Secretary delegated to the DAB responsibility for adjudicating civil money penalties and exclusions imposed under a wide range of fraud and abuse authorities. In 1993, the Secretary delegated to the DAB responsibility for hearing appeals in enforcement cases brought by the Centers for Medicare & Medicaid Services (CMS) (formerly known as the Health Care Financing Administration or HCFA). Also, when the Social Security Administration (SSA) became an independent agency in 1995, the Secretary delegated to the DAB the Medicare Appeals Council function of hearing appeals in Medicare coverage and payment cases and entitlement cases.

Last revised: November 20, 2003

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