Medicare and Pharmaceutical and Technology Ombudsman

Medicare and Pharmaceutical and Technology Ombudsman

We are pleased to announce that James Bailey is now serving as the Medicare Pharmaceutical and Technology Ombudsman, a role that was established by section 4010 of the 21st Century Cures Act to support customer service and innovation in the Medicare program. Bailey will receive and review questions and concerns from pharmaceutical, biotechnology, medical device, diagnostic product manufacturers and other stakeholders regarding Medicare coverage, coding, and payment for products already covered or for which coverage is being sought.  He will also collaborate closely with our other Medicare program ombudspersons in the CMS Offices of Hearings and Inquiries.

In addition to helping stakeholders navigate the Medicare Program, as the new Medicare Pharmaceutical and Technology Ombudsman, Bailey is also interested in learning about beneficiary experiences and sharing this information with others in CMS to help promote transparency and predictability.

The Ombudsman does not duplicate or replace current existing processes, including grievance procedures, appeals, judicial hearings, or other formal avenues stakeholders may access. However, the Ombudsman may look into how procedures were followed in these processes and provide feedback to CMS regarding policies and procedures that works well, as well as opportunities for improvement.  The Ombudsman also cannot advocate for new coverage, coding or payment within the Medicare Program, but can facilitate information exchange.