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Author Archive for: Tom Matson, CMSP

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CMS Releases Updated Life Tables

On December 17, 2012, The Centers for Medicare and Medicaid Services (CMS) posted a notice on its website indicating the Centers for Disease Control has published its 2008 United States Life Tables.   The notice goes on to state that newly submitted WCMSA proposals received by the COBC, uploaded via the web portal or reopened on or after January 19, 2013 should utilize the 2008 United States Life Table 1 for all life expectancy calculations.

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28 Days

What would have seemed impossible just a short time ago actually came true for us earlier this month.  On July 10th we reluctantly submitted yet another MSA to CMS for approval via the web-based portal.  We then subsequently scheduled a routine follow up for July of 2022! Much to our surprise, on August 6th, just 28 days later, we received a notification from CMS that our submitted MSA had been approved.

What had been promised to the MSA industry had actually been delivered, and we were able to relay the good news to our customer.  I have since heard similar stories from our friends in the industry with approval times coming back in as little as 7 days.  We’re not sure how long this good fortune will last, but here’s hoping for the best!

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CMS Announces Plans to Move Forward With WCMSA Portal

The Centers for Medicare and Medicaid Services (CMS) is currently testing the web-based Workers’ Compensation Medicare Set-Aside (WCMSA) Portal.  The goal of this program is to give case submitters the ability to enter case information, upload their documentation, and receive status information through the website.  According to the CMS website, “This secure Web portal will greatly improve the efficiency of the submission process for WCMSAs, including receipt of the proposal by its Workers’ Compensation Review Contractor (WCRC).”

In our opinion, greener pastures may be on the horizon when you couple the plan to launch this portal with the awarding of the new WCRC contract.  The effectiveness of these programs is yet to be seen, but it certainly is reassuring to see CMS addressing some longstanding issues submitters have had with the submission and review of WCMSAs.

To view this latest announcement from CMS, please click here.

 

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MSPRC Resumes Issuance of Rights & Responsibilities Letter

On June 10, 2011, the Medicare Secondary Payor Recovery Contractor (MSPRC) resumed the process of issuing their Rights & Responsibilities (R&R) Letters.

On the heels of a recent court decision in Arizona (see Haro v. Sebelius), the MSPRC announced a temporary suspension of R&R letters and Demand letters.  This led many to speculate that the Haro decision played a role in the review the MSPRC was conducting on the letters.  In the Haro Case, the US District Court of Arizona held, in part, that CMS couldn’t collect disputed amounts from beneficiaries or attorneys.

The new R&R letter certainly appears to supports that opinion. The new wording in the letter specifically states “Medicare will not take any collection action during the pendency of any appeal or waiver request.”  There are several additional changes to the letter, however the suspension of the collection efforts during an appeal is the most noteworthy.

To read the updated Rights and Responsibilities Letter, please click here.

Superior Court of New Jersey Allows Attorney’s Fees to be Taken from LMSA
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Superior Court of New Jersey Allows Attorney’s Fees to be Taken from LMSA

In Hinsinger v. Showboat Atlantic City, an opinion reached in January 2011 but not published until late May 2011, the Superior Court of New Jersey held that a portion of a Medicare beneficiary’s attorney’s fees associated with procuring settlement may be deducted from a Liability Medicare Set Aside (LMSA) account in determining the amount of money to be set aside for injury-related, otherwise Medicare allowable, medical expenses.  Interestingly, Judge Rochelle Gizinski also addressed several different issues pertaining to MSAs that could have far-reaching effects on the settlement community.

First, and arguably the most significant, Judge Gizinski opined that the workers’ compensation federal regulations and the workers’ compensation CMS memos apply to liability MSAs.   This is a first, as far as we know, and could possibly have a major impact for liability settlements in the future.  The court justified this position by stating, “The statutory and policy reasons for creating both of them are the same: to protect the government, and the Medicare system in particular, from paying medical bills for which the beneficiary has already received money from another source.”

Second, the court continued on to determine that an attorney can recover a portion of their fees obtained on behalf of a client in a third-party liability case directly from the Medicare Set Aside itself.   The opinion provides an analysis of the wording found in 42 CFR § 411.37, which outlines allowable deductions from MSAs when the recovery is sought from the party that received the primary payment.  The court felt that 42 CFR § 411.37 was unclear as to whether or not the regulations apply only to recovery funds already paid by Medicare (conditional payments), or to funds obtained for future medical expenses.  However, based on the language in the regulation and the headings themselves, the court found that 42 CFR § 411.37 could apply to funds awarded for future medical expenses as it does to conditional payments.

Third, the opinion also referenced the May 7, 2004 CMS memo entitled “Medicare Secondary Payer- Workers’ Compensation (WC)-INFORMATION.”  This memo specifically prohibits administrative expenses or attorney costs associated with the establishment of the MSA from being taken out of the account.  The court found that since it already established that the rules and regulations created in workers’ compensation situations also apply to set asides created in other situations, then this memo should also apply to third-party liability settlements as well.  Interestingly, the court held that this directive applies only to attorney’s fees specifically associated with the establishment of the trust, and does not apply to attorney’s fees incurred in the procurement of funds in a civil suit.

The court held that its decision to apply 42 CFR § 411.37 to funds obtained in a civil action and placed within an MSA was also consistent with the general principles of equity.  Allowing Medicare to avoid paying its fair share of expenses incurred in the procurement of a settlement, judgment, award or other payment would unfairly force a claimant to pay for those fees (resulting in a smaller amount of net proceeds) and would discourage Medicare beneficiaries from filing claims against liable third parties when they have a legal right to do so.

CMS has traditionally remained silent when pressed for clarification on issues related to liability MSAs, and in some instances, workers’ compensation MSAs.  Courts across the country have been left to their own devices to determine a fair and equitable way to consider Medicare’s interest in their cases.  The court’s decision in this case, along with others (see Haro v. Sebelius and Bradley v. Sebelius), may not be what CMS had in mind when issuing what little guidance they have offered up.  On the other hand, the personal injury settlement community has clearly begun to police itself, which could very well have been CMS’s plan all along.  The liability settlement community is calling for additional directives from CMS, and if CMS continues to remain silent on the issues then they can expect the courts to continue making their own interpretations.

 

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Western District of NY Issues MSP Protocol

On May 6, 2011, Assistant U.S. Attorney for the Western District of New York (WDNY) Robert G. Trusiak issued the WDNY Medicare Secondary Payor Protocol, which outlines a voluntary standard operating procedure for resolving the future medical component of a liability settlement involving a Medicare beneficiary. While this policy was not released by the Centers for Medicare and Medicaid Services (CMS), it is the first bit of guidance offered by the federal government on the issue of Liability Medicare Set Asides (LMSAs).

Before the application for MSP compromise can be filed with the US Attorney’s office for the WDNY, the following criteria must be met:

  1. Medicare must have been notified of the pending liability claim and subsequent settlement of the claim.
  2. A letter from the Medicare Secondary Payer Recovery Contractor (MSPRC) must be obtained stating that the conditional payment obligation concerning repayment of any Medicare liens related to the claim was resolved, or provide adequate assurances to that effect.

Once the application criteria has been met, appropriate steps must be taken to ensure the application includes the following:

  1. A copy of the MSPRC letter stating the matter concerning repayment for any Medicare liens related to the claim was reviewed and resolved or provide adequate assurances to the effect.
  2. Proposed LMSA concerning payment for the future medical items and services related to the claim.
  3. An agreed copy of the settlement agreement subject to the completion of MSP obligations.
  4. A joint statement from the applicants certifying the following:
    a. The value of the agreed settlement equals or exceeds $350,000.
    b. The plaintiff is a Medicare beneficiary as that term is defined under 42 C.F.R. §400.202.
    c. CMS was requested to approve the LMSA, but no substantive response has been received for at least 60 days from the date of the letter to CMS; and
    d. An affidavit from the preparer of the LMSA that it is true and correct based on the Medicare beneficiaries medical records and the injuries being released as well as in the conformance with the WCMSA submission checklist as published by CMS.

The U.S. Attorney’s office for the WDNY reserves the right to request additional information from the parties, however upon receipt of all required information will issue a release. The release will compromise the LMSA obligations related to the settlement, judgment, award or other payment. It is important to note that the WDNY MSP Protocol is not available for liability cases involving mass torts, and again, is not the policy of CMS.

On the positive side, this protocol does provide more peace of mind to those parties settling liability claims involving Medicare beneficiaries in the WDNY’s venue. However, while it is refreshing to see an arm of the federal government offer guidance on the issue of LMSAs, it should be noted that the agency given the task of enforcing the Medicare Secondary Payer (MSP) Statute, CMS, has not endorsed the policy at all. The last statement of the protocol says clearly, “This is not the policy of CMS”.

This protocol falls short of addressing the heart of the problem, which is CMS’ insistence on viewing LMSAs through the same lens as they have viewed WCMSAs. They are clearly two different beasts, and this does nothing to change that fact. For example this protocol leaves many questions such as what to do if the settlement is under $350K, or if apportionment of the set aside is an accepted practice. While we commend the WDNY for taking a position on this issue, it would be helpful to see them tackle the more controversial elements of handling LMSAs.

To view the WDNY MSP Protocol in its entirety, please click here.

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Florida 1st DCA Issues Kauffman Opinion

On March 23, 2011, Florida’s First District Court of Appeals (1st DCA) issued its opinion in Kauffman v. Community Inclusions, holding that the provisions of Fla. Stat. 440.34,as amended in 2009, limit claimant attorney fee awards. In its four-page opinion, the 1st DCA rejected the plaintiff ‘s argument that Florida Statute 440.34 is unconstitutional.

In addition to the 1st DCA’s ruling that the statute in question applies to both court “awarded” fees and court “approved” fees, it also rejected the plaintiff’s challenges to the statute’s constitutionality under the legal theories of equal protection, due process, separation of powers, and access to the courts. The 2009 statutory changes to 440.34 have radically altered the Court’s rulings regarding attorney’s fees awarded and approved in workers’ compensation cases.

With whispers of an appeal on the horizon, it can be reasonably assumed that the plaintiff attorney community must hope that the Florida Supreme Court will accept an appeal and overturn the decision of the 1st DCA.

To read the opinion of the 1st DCA, please click here.

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The Debate Continues Over Claimant Attorney Fees In Florida

There has been a recent resurrection of the near decade-long debate within the Florida legal community surrounding the interpretation of Section 440.34 subsections 1 and 3 of the Florida Statute, which addresses claimant attorney’s fees in workers’ compensation cases.  To understand how and why this argument has resurfaced it is important to revisit the subject from the beginning.

This entire issue dates back to 1968 when the Florida Supreme Court ruled on Lee Engineering v. Fellows.  In their brief, the justices commented on the fairness of claimant attorney’s fees stating that “it is obvious that fees should not be so low that capable attorneys will not be attracted, nor so high as to impair the compensation program.”  As a result the justices introduced six criteria for determining the reasonableness of claimant attorney’s fees, which can be read by clicking the Lee Engineering v. Fellows link below.

Fast forward to 2003.  Florida had been happily plugging along with “reasonable fee” settlements for over 30 years since the Lee Engineering decision.  However, in 2003, Florida was one of the nation’s leaders in workers’ compensation rates which caused industries to avoid Florida, or leave Florida altogether.  Many have argued that contributing factors included a housing boom, increased workers, and an increased attorney presence in the marketplace, etc.  Lawmakers felt that claimant attorneys fees needed to decrease so the Florida Statute was amended to include a subsection that outlined a specific schedule that judges were to follow when determining the reasonableness of claimant attorney fees based on a percentage of the settlement (440.34 (1)).  This resulted in lower claimant attorney fees and remained the standard until 2009 when the Emma Murray v. Mariner Health case was decided.

In the Emma Murray case, the Florida Supreme Court was faced with an interesting conflict.  Florida Statute 440.34(1) spells out the fee schedule, where 440.34(3) simply called for a “reasonable” fee for any employer/carrier paid attorney’s fee.  The judges were faced with a question of what should occur when the subsection 1 fee schedule is so unreasonable that it violates the reasonable fee language in subsection 3.  The judges ruled that the reasonable fee language in subsection 3 was more specific in nature because it directly dealt with the issue of employer/carrier paid attorney’s fees, whereas the fee schedule language in subsection 1 discussed attorney’s fees but was silent as to its interpretation of employer/carrier paid fees.  So they ruled that the specific language controlled the general language and as a result reasonable hourly attorney fees for Claimant attorneys once again ruled.  So, fees went up again…but not for long.

In July of 2009, on the heals of the Emma Murray decision, lawmakers again descended on Tallahassee in an effort to reverse the effects of the Emmy Murray decision and reduce plaintiff legal fees.  As a result, legislators removed the term “reasonable” from subsection 3 which paved the way for the fee schedule laid out in subsection 1 to guide judges in their decision on attorney’s fees…until recently.

Often referred to as Emma Murray 2, Kauffman v. Community Inclusions once again has shown the pitfalls judges were facing when utilizing the guidance offered in subsection 1 of the statutes (440.34(1)).  In the Kauffman case, a carrier denied compensability for damages Jennifer Kauffman sustained while attempting to transfer a patient into a recliner.  At trial the injury was found to be compensable, and the carrier was ordered to pay $3,417.03 to Ms. Kauffman.  Neither party disputed the amount owed to Ms. Kauffman, however the Judge of Compensation Claims (JCC) stated that he was bound by the statutory fee schedule regarding claimant attorney’s fee that was spelled out in subsection 1 of the Florida Statutes.  As a result, the prevailing claimant attorney was entitled to $684.41, or about $6.84 per billable hour.  In his Order, Judge E. David Spangler, Jr. commented that, “While the undersigned is constrained to follow the legislatively mandated scheme, I cannot help but question whether this scheme is consistent with the otherwise stated legislative intent…”.  He also stated in a footnote that, “Based on the testimony presented by the claimant the undersigned would find a reasonable fee in this matter to be a factor of the stated hours 100.3 hours and an appropriate billable rate for this particular matter of $250 per hour, totaling $25,075.”

Many would argue that the Kauffman case encompassed everything that was wrong with the current state of affairs surrounding claimant attorney’s fees and workers’ compensation cases in Florida.  One could even make a very compelling argument that claimant attorney’s had been on the look out for a case like this ever since lawmakers removed the term “reasonable” from the statue back in the summer of 2009.  The judges in the Emma Murray case failed to address the constitutionality issue they were faced with, instead choosing to focus their attention on the conflicting language in 440.34 (1) and (3).  Kauffman has now forced the courts  to revisit the constitutionality issue, which they did during oral arguments in the 1st District Court of Appeals on January 13, 2011.  It can be safely assumed that the anticipated ruling from the 1st DCA is sure to be a game changer.

To read Lee Engineering v. Fellows, please click here
To read Emma Murray v. Mariner Health, please click here
To read Kauffman v. Community Inclusions, please click here
To watch the video of the Kauffman v. Community Inclusions oral arguments heard by the 1st DCA, please click here.

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CMS Releases Updated List of Top 10 Submitter Errors

The Centers for Medicare and Medicaid Services (CMS) recently released an updated list of the Top 10 Submitter Errors, as well as a listing of helpful hints to avoid these recurring issues.  The errors that have received the most attention include incomplete or insufficient medical treatment records for the last two years of treatment, and insufficient proof of drugs, dosages, and frequencies for the last two years of treatment.

While changes in CMS policy (i.e. prescription drug pricing and rated age requirements) have led the industry to seek out ways to reduce the cost of an MSA, this list is evidence that many Medicare Set Aside (MSA) submitters have lost sight of basic CMS requirements of a submitted Workers’ Compensation Medicare Set Aside Arrangement (WCMSA).  In our experience as a qualified MSA allocator and professional administrator, we see many new and inexperienced allocators making these same mistakes, too.  The lesson to be learned by this list is that the more qualified your MSA vendor is, the less likely you are to see a CMS rejection.

To view the “Top 10 Submitters Errors and Helpful Hints to Avoid Them” list, please click here.

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The Centers for Disease Control Publishes 2006 U.S. Life Tables

On July 9, 2010, The Centers for Disease Control (CDC) published the 2006 United States Life Tables.  This new table comes on the heels of the 2005 life table that just went into effect about three months ago.  Effective July 19, 2010, the CMS will begin referencing CDC’s Table 1: Life table for the total population: United States, 2006 for all Workers’ Compensation Medicare Set Asides (WCMSAs).  As a result, CMS will apply the new life table on any newly submitted or reopened WCMSA received on or after July 19, 2010.

To view the CDC’s Table 1: Life table for the total population: United States, 2006, please click here.

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Dr. Ronald Berwick is New CMS Head

President Obama, by way of a recess appointment, appointed Dr. Donald Berwick, age 63, this week as the administrator of the Centers of Medicare and Medicaid Services (CMS), a post that has been vacant since 2006. Dr. Berwick is a pediatrician and a professor at the Harvard Medical School. He is also the president and CEO of the Institute of Healthcare Improvement (IHI), a not-for-profit organization based in Cambridge, Massachusetts, working to improve healthcare in the US and throughout the world.

His supporters, which include the American Medical Association, the American Hospital Association, the AARP, AFL-CIO and many health organizations, say that he is an expert, dedicated to improving health care quality and safety while at the same cutting cost. His critics say Dr. Berwick is a proponent of rationing healthcare and loves the socialized British National Health System.

Liberals and conservatives are butting heads (so, what else is new) that this Obama appointment was done while the Senate was in recess thereby by-passing the senate confirmation process until the end 2011. Liberals are saying that this important appointment just can’t wait. Conservatives are saying Obama shouldn’t have bypassed the senate confirmation process.

For the official White House announcement click here.

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CMS Announces Direct Data Entry Option

The Centers for Medicare and Medicaid Services (CMS) recently announced a more effective reporting option for “small reporting” Responsible Reporting Entities (RREs).  This new method, referred to as the Direct Data Entry (DDE) Option, is only available for those RREs who will be reporting 500 or fewer claim reports per calendar year.

Those RREs that are able to utilize this DDE Option will be able manually enter and submit their data rather than submit an electronic file over the Section 111 Coordination of Benefits Secure Website (COBSW).  Small reporters may register for DDE as a reporting option beginning October 1, 2010.  If an RRE has already registered under the current methods, the Account Manager for the RRE will be able to change their reporting method on or after October 4, 2010.  These small reporters will be able to begin reporting using this DDE option on January 3, 2011.

The CMS goes on to state that there will be no testing period required for RREs using the DDE option, and claim information should be submitted one claim at a time “as soon as conditions related to the claim require reporting under Section 111.”  Also, those small reporters using the query system should be aware that if an injured party’s information does not match up to a Medicare beneficiary during the DDE process, it WILL count toward the RREs limit of 500 claims per year.

It is important to note that RREs utilizing the DDE option have the same responsibilities as any other RREs.  While this does provide an easier alternative for those RREs that have a very limited number of claims to support, those RREs that are borderline should take precautions to assure that they do not exceed the 500 claims per year limit.

To view this latest memo in its entirety, please click here.

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CMS Revises Recent Statement on Rated Ages

The Centers for Medicare and Medicaid Services (CMS) recently issued a revised statement to be included as part of a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) proposal.  Effective immediately, the Rated Age certification originated by the May 14, 2010 memo is revised to state the following:

“Our organization certifies that all rated ages we have obtained and/or have knowledge of regarding the claimant, and generated at any time on or after the Date of Incident for the alleged accident/illness/injury/incident at issue, have been included as part of this submission of a proposed amount for a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) to the Centers for Medicare and Medicaid Services.”

As was true with the prior statement released on May 14, 2010, The CMS goes onto to state that they will not accept any variations of this latest statement.  If a WCMSA proposal is submitted without this exact wording, they will not accept the rated ages provided and will estimate the claimant’s remaining life expectancy using actual age.  The CMS will continue to accept WCMSA proposals using the previous wording up to and including June 30, 2010.  All other requirements of acceptable proof of a rated age remain unchanged.

To view this latest memo, please click here.

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CMS Offers Clarity to Use of Non-Covered Part D Drugs and Rated Ages

On May 14, 2010, the Centers for Medicare and Medicaid Services (CMS) issued a new memo that attempts to clarify the use of non-covered part D drugs in a Workers Compensation Medicare Set Aside Arrangement (WCMSA). Per this latest memo:

1) Effective June 1, 2010, workers’ compensation cases that are settled prior to June 1, 2010, and include non-covered Part D drugs as part of the WCMSA, CMS will consider funds spent for those non-covered Part D drugs as being an appropriate expense from the WCMSA.
2) For those workers’ compensation claims that are not settled prior to June 1, 2010, and also include non-covered Part D drugs as part of the WCMSA, CMS will consider a re-pricing of those cases. Once the re-pricing has been completed, the claimant may not use the funds from their WCMSA to pay for non-covered Part D drugs.
3) For those workers’ compensation cases settled on or after June 1, 2010, and where the settlement does not include non-covered Part D drugs as part of the WCMSA, claimants may not use funds from their WCMSA to pay for those non-covered Part D drugs.

This memo also rescinds the previous rated age statement that stated “all rated ages obtained on the claimant have been included”. The new language regarding rated ages that must be included on all submissions reads as follows:

“Our organization certifies that all rated ages obtained on the claimant, at any time during that individual claimant’s lifetime, have been included as part of this submission to the Centers for Medicare & Medicaid Services.”

This latest memo goes onto state that the CMS will not accept any variations of this language, and that this language must be included without exceptions. If this language is not included than the CMS will not accept the rated age provided and will estimate the claimant’s remaining life expectancy using Actual Age. All previously released information on the use of rated ages for a claimant remain unchanged, and acceptable proof of rated ages is demonstrated through inclusion of independent rated ages on the letterhead of an insurance carrier or settlement broker.

To view this memo in it’s entirety, please click here.

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Article Addresses Potential for Third Party Liability MSAs

We recently came across an article written by Judge Richard L. Gilbert, who is a retired judge in Sacramento, California. His article offers an informative and thoughtful commentary on the current issues surrounding MSAs in Third Party Liability cases. We found this article highly enlightening, and the article is being reposted here with Judge Gilbert’s permission.

Medicare “Set-Aside” Requirements in Third Party Liability Cases
Panic: No/Prepare: Yes

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President Obama Nominates New CMS Administrator

On April 19, 2010, President Barack Obama nominated Dr. David Berwick to be the new Administrator of the Centers for Medicare and Medicaid Services (CMS).  Dr. Berwick is currently the President and CEO of the Insitute for Healthcare Improvement, and is a professor at Harvard Medical School and the Harvard School of Public Health.  In addition to being a summa cum laude graduate of Harvard College, Dr. Berwick also holds a Master in Public Policy degree from the John F. Kennedy School of Government. He received his medical degree from Harvard Medical School, where he graduated cum laude.

“Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost,” President Obama said. “That’s one of the core missions facing our next CMS Administrator, and I’m confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

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CDC Publishes 2005 US Life Tables

The Centers for Disease Control (CDC) recently published its 2005 United States Life Tables. The MSA industry should take note that effective April 12, 2010, the Centers for Medicare and Medicaid Services (CMS) will begin referencing these most recent tables for newly submitted, or reopened, workers compensation Medicare set aside (WCMSA) life expectancy calculations.

To view the CDC’s Table 1: Life Table for Total Population: United States, 2005, please click here

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Patrick Murphy (D-PA) introduces Medicare Secondary Payer Enhancement Act of 2010

On March 9, 2010, Representatives Patrick Murphy (D-PA) and Tim Murphy (R-PA) introduced the Medicare Secondary Payer Enhancement Act of 2010.  This bill was created by the Medicare Advisory Recovery Committee (MARC) and addresses a number of items including conditional payments and the reporting of workers’ compensation payments.  It is no secret that the implementation of Section 111 reporting requirements has created a number issues that has left the Non-Group Health Plan Required Reporting Entities (NGHP RREs) reeling for answers.  This bill was created to address some of those issues by amending title XVII of the Social Security Act.

According to the MARC, if enacted the bill will:

  • Revise the information flow so that MSP conditional payment demand occurs before settlement
  • Provide a safe harbor alternative if the Center for Medicare and Medicaid Services is unable to provide a final demand before settlement
  • Provide a right of appeal to a non-group health plan settling party
  • Establish a $5,000 threshold on MSP recoveries and set a three year statute of limitations
  • Protect beneficiaries’ from having to disclose their Social Security Numbers (SSN) or Health Insurance Card Number (HICN).

To view this proposed bill in it’s entirety, please click here.

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The CMS Again Delays Section 111 MIR Implementation Deadline

The Centers for Medicare and Medicaid Services (CMS) has once again delayed the final implementation deadline for Section 111 Mandatory Insurer Reporting (MIR) compliance. On February 16, 2010, the CMS advised all Non-Group Health Plan Responsible Reporting Entities (NGHP RREs) that the date for first production NGHP Input Files has been changed from April 1, 2010 to January 1, 2011.

The notice went on to state that testing of NGHP file data exchange will continue and all testing will be completed by December 31, 2010. It also stated that all NGHP RREs should now be registered with the COBC and either participating in or preparing for file testing status. The CMS is encouraging those NGHP RREs that have completed data exchange testing to proceed to production file data exchange status.

The notice advised that the next version of the NGHP User Guide will be posted on the CMS website during the week of February 22, 2010. An alert is also forthcoming that will list the necessary steps NGHP RREs can take to assure their compliance with Section 111 reporting requirements.

To view this latest alert in its entirety, please click here.

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Trade Groups Ask HHS to Delay MSP Reporting Requirement Deadline

Three insurer trade organizations have sent a joint letter to the Secretary of Health and Human Services, Kathleen Sebelius, seeking to extend the April 1, 2010 implementation of the Medicare Secondary Payer (MSP) mandatory insurer reporting (MIR) requirement. This letter outlines five major reasons as to why the Department of Health and Human Services should consider extending the deadline:

  1. Reporting Guidance: the Centers for Medicare and Medicaid Services (CMS) has yet to issue final guidance on some issues.
  2. Collection of Social Security Numbers (SSN) or Health Insurance Claim Numbers (HICN): insurance and self-insured companies are concerned about the inability to obtain critical data elements such as SSNs or HICNs.
  3. Confidentiality and Security of the Data: there are still serious concerns that the CMS is not using the most effective security and encryption technology to ensure the data submitted is properly secured.
  4. Inadequate testing period: there are concerns that the testing period CMS used was too short for required reporting entities (RREs) and CMS to properly ensure that their systems were operational prior to the reporting deadline.
  5. Penalties: there is a belief that the $1000 per day, per claim penalty is excessive. There is further belief that this penalty should not be enforced on the initial reports submitted by RREs.

If successful, this would represent the third extension since Section 111 of the Medicare, Medicaid, SCHIP Extension Act of 2007 (MMSEA) first called for MIR compliance.

To read the letter in its entirety, please click here.