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Medicare Set-Aside Bill Introduced in House and Senate

On June 4, 2015, Senators Rob Portman (sponsor, R-OH) and Bill Nelson (co-sponsor, D-FL) introduced Senate Bill 1514 into the U.S. Senate to amend the Medicare Secondary Payer Statute. An identical bill, HR 2649, was also introduced in the House the same day by Representatives Dave Reichert (sponsor, R-WA) and Mike Thompson (co-sponsor, D-CA). These bills are identical to S 2731, introduced in 2014, which did pass. It is also very similar to House Bill 1982, which was introduced in 2013 and also did not pass.

S 1514 and HR 2649 primarily limit the application of the Medicare Secondary Payer (MSP) statute and provide for a “Qualified Medicare Set-Aside” as a way to comply with the statute, as follows:

Threshold for MSP Treatment
These identical bills amend the Medicare Secondary Payer (MSP) statute to provide an exemption for workers’ compensation settlements for any of the following:

  • The total settlement is $25,000 or less
  • The claimant is not eligible for Medicare at settlement date and is unlikely to become eligible for within 30 months
  • The claimant is not eligible for post-settlement payment of medical expenses by a workers’ compensation plan
  • The settlement agreement does not limit or extinguish the right of the claimant to have his medical bills paid by the workers’ compensation insurance plan.

Qualified Medicare Set-Aside
They amend the MSP Statute to provide that if a workers’ compensation settlement includes a “qualified Medicare set-aside” (QMSA) then that settlement will satisfy any obligation, with respect to future payment reimbursement obligations under Section 1395y(b)(2) of the MSP statute. MSA submissions to CMS would remain optional, however there would be new approval deadlines and appeals options added.

Requirements of a Qualified Medicare Set-Aside:

  • Reasonably takes into account the full payment obligation for present and future medical payments.
  • It must be determined based on the Illness or injury giving rise to the workers’ compensation claim involved, The age and life expectancy, reasonableness of and necessity for future medical expenses, duration of and limitations on benefits payable under the workers’ compensation law or plan, regulations and case law relevant to the state workers’ compensation law or plan
  • It must include payment for items and services that are covered by the workers’ compensation law or plan
  • It must be based on the applicable workers’ compensation state fee schedule
  • In the case of a compromise settlement, a QMSA can be calculated using a proportional adjustment that reduces the QMSA by the same proportion that the total settlement was reduced.

Approval of a QMSA
The two new proposed bills maintain the current optional submission and CMS review process, however they give the submitter some new and significant appeals rights. They give CMS 60 days to review the QMSA. If CMS fails to meet that deadline, the submitter has 30 days to appeal to CMS or to an administrative law judge. If CMS meets the deadline, the submitter can still appeal CMS’ decision within 30 days to CMS, an administrative law judge or a judicial review. CMS again has 30 days to respond to this appeal. If CMS responds to the appeal with a decision within 30 days, the submitter can appeal that decision, within 30 days to an administrative law judge. If CMS does not respond within 30 days, the submitter can appeal to an administrative law judge. If the administrative law judge does not respond within 90 days, the submitter can request a judicial review.

Optional Direct Payment of Medicare Set-Aside
A claimant or payer of a workers’ compensation settlement agreement may elect, upon written consent of both parties, to transfer to the Secretary a direct payment of the QMSA. This election will satisfy any payment obligations under Section 1395y(b)(2) of the MSP Statute.

Protection from Certain Liabilities
No one shall be liable for any payment amount established under a Medicare set-aside for an item or service provided to the claimant that is greater than the related workers’ compensation fee schedule amount. In addition, a provider may not bill a Medicare set-aside more than the payment rate used in the Medicare set-aside or the Secretary may apply sanctions.

Election of Professional or Beneficiary Self-Administration of an MSA
Nothing in these amendments prevents an individual from electing to utilize professional administration services or to self-administer payments of their MSA.

Treatment of State Workers’ Compensation Law
If a workers’ compensation settlement agreement is accepted in accordance with the workers’ compensation law of a jurisdiction, then that acceptance shall be deemed conclusive. That includes determination of reasonableness of the settlement value, any allocation of funds, the projection of future indemnity or medical benefits that may be payable under state workers’ compensation law.

Commentary

There are many positives with this bill, but one major concern. On the positive side, I think most agree that a $25,000 threshold, time limits for CMS approval and appeals rights are much needed in the MSA process.

However, the most controversial provision is the Direct Payment Option, where with the written consent of both settling parties, the MSA can be paid directly to Medicare to satisfy the payment provisions of the Medicare Secondary Payer provisions. This apparently would mean that, if that option is chosen, any conditional payments would not have to be repaid to Medicare and no MSA account would need to be set up. Many concerns have been voiced about this option, because the current system of funding an MSA has many benefits over paying that money to the federal government. Some of those concerns include:

    • Structured settlements would not be available if parties pay the full MSA amount to Medicare and therefore the present value discounts, tax benefits and conservation of principle benefits of structures would also be lost.
    • Future inheritance of any remaining MSA funds of the claimant, upon the death, would not be available because all the MSA funds were paid to the federal government.
    • Medicare deductibles and co-pays may have to be paid sooner by the claimant, because Medicare would start paying injury related medical bills right away. This would cost the claimant more money.
    • Professional administration, a vehicle that has worked very well for many years to save Medicare money and help the claimant conserve his MSA money, would not be available on these cases.
    • Medicare may not have the resources and systems in place to pay injury related medical bills because currently they only pay Medicare allowable medical bills.

Medivest will continue to monitor the progress of these bills and will keep you informed as news develops.

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MSP and MSA Bill Introduced in the U.S. Senate

A year ago we wrote a post saying that the 15% safe harbor payment provision of House Bill 1982 was impractical and problematic. Well, it seems that Senator Bill Nelson (D-FL) has come to the same conclusion. On July 31, 2014, Senator Nelson introduced Senate Bill 2731, the Senate version of House Bill 1982 that drops that controversial provision.

H.R. 1982 allowed a payment of 15% of the settlement to be paid directly to Medicare to satisfy the obligations under the MSP statute. This provision is problematic, in our opinion, because it would be a net loss to the Medicare Trust Fund, it would not allow any unspent claimant monies to be available to the claimants’ beneficiaries upon death, and would be costly to claimants because it would require them to pay Medicare co-pays and deductibles out of pocket right away. Others have pointed out that a law that allows a taxpayer to turn over their money to the US government in exchange for protection from liability could be-unconstitutional.

S. 2731 adds a section that allows the claimant to continue to “elect to utilize professional administration services or to self-administer payments of their Medicare Set-Aside in accordance with existing law”.

It also still allows for an optional payment of the Medicare Set-Aside funds directly to the Medicare Trust Fund in order to obtain “protection from certain liability”. This concept is fraught with some of the same problems as the 15% safe harbor payment. It would not allow the claimant’s unspent MSA funds to pass to their heirs upon death, it could immediately cost the claimant more money because of any applicable Medicare co-pays and deductibles, and it may be unconstitutional. Also, how wise is it for the claimant to transfer his MSA monies to a Medicare Trust Fund that is scheduled to be insolvent in 2030?

The MSA process certainly has some problems.  We need to find a way to streamline the process and provide finality and certainty to all parties. But this bill is not the answer.

The bottom line is this: no matter how many changes we make to simplify the process for the settling parties, in the end, if a competent and accountable third party does not professionally administer the MSA funds, MSP compliance is an expensive failure. Why? Because we just cannot expect an average person, who is awarded settlement monies, to administer that money with the knowledge, commitment and discipline required by the complex MSP rules. Lets face it, self-administration, by and large, just does not work and the sad truth is that it results in the vast majority of settlement monies being spent incorrectly with Medicare picking up the tab. The correct solution is one that provides certainty and simplicity for payers, coupled with professional administration in order to protect the claimants and the Medicare Trust Fund.

Medicare Set-Aside Bill Introduced into U.S. House Again

H.R. 1982, the “Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2013” was introduced into the U.S. House on May 15, 2013 by its sponsors, Rep. David Reicheart (R-WA) and Rep. Mike Thompson (D-CA). They claim in a press release that, “This bill will make sure hard working families medical claims are processed efficiently and quickly, it will reduce bureaucratic headaches for businesses, and it will save taxpayers money”.   Groups that support the bill include the American Insurance Association (AIA), the American Bar Association (ABA), the National Council of Self-Insurers (NCSI), Insurers Association of America (IAA), UWC-Strategic Services (UWC) and the Workers Injury Law Group (WILG).

Govtrack.us gives the bill a 2% chance getting past committee.  That could be because a previous, almost identical version of this bill, H.R. 5284 did not make it out of committee in the previous session of Congress.

Summary of H.R. 1982

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Threshold for MSP Treatment – Section 2(a) amends the Medicare Secondary Payer (MSP) statute to exempt certain workers compensation settlements from the MSP statute if any of the following conditions are met:

  1. The total settlement does not exceed $25,000
  2. The claimant is not eligible for Medicare at settlement date and is unlikely to become eligible for 30 months
  3. No future medical expenses will be paid by the workers’ compensation plan after the date of the settlement.
  4. The settlement agreement does not limit or extinguish the right of the claimant to payment of future medical bills

A Qualified Medicare Set-Aside (QMSA)– Section 2(b) amends the MSP statute to provide that if a workers’ compensation settlement includes a Qualified Medicare Set-Aside then that settlement will satisfy any obligation with respect to present or future payment reimbursement obligation under Section 1395y(b)(2) of the MSP statute.

A (QMSA) is defined as a Medicare set-aside that reasonably takes into account the full payment obligation for present and future medical payments.  It must give due consideration to: the illness or injury, age and life expectancy, the reasonableness of and necessity for future medical expenses, the duration of and limitations on benefits payable under the workers’ compensation law or plan and the relevant State workers’ compensation regulations and case law.  A QMSA must include payment for items and services that are covered by the workers’ compensation law or plan involved.  The QMSA must be based on the applicable workers’ compensation State fee schedule.  A QMSA can be calculated using a proportional adjustment for compromised settlements that reduces the QMSA by the same proportion that the total settlement was reduced.

15% Safe Harbor Payment – Section 2(b) also provides for a 15% (of total settlement) “safe harbor amount” paid directly to Medicare to satisfy any future medical obligations under the MSP statute.  All settling parties must agree in writing and can modify the percentage if necessary to not cause a significant negative impact.

QMSA payment greater than payment under workers’ compensation law – No one shall be liable for any payment amount established under a Medicare set-aside for an item or service provided to the claimant that is greater than the related workers’ compensation fee schedule amount.  In addition, a provider may not bill a Medicare set-aside more than the payment rate used in the Medicare set-aside or the Secretary may apply sanctions.

Treatment of state workers’ compensation law – If a workers’ compensation settlement agreement is accepted in accordance with the workers’ compensation law of a jurisdiction, then that acceptance shall be deemed conclusive.  That includes determination of reasonableness of the settlement value, any allocation of funds, the projection of future indemnity or medical benefits that may be payable under State workers’ compensation law.

Concluding Thoughts

Although H.R. 1982 attempts to correct some perceived problems in the workers’ compensation MSA program by the groups listed above, it has a very slim chance of passing.

The most impracticable part of this bill is the 15% safe harbor payment to Medicare as an alternative to doing a Medicare Set-Aside.  I see three problems with this, 15% safe harbor part of the bill:

  1. It would be revenue negative to the U.S. Treasury because it would be only be used for only those settlements that it would cost-effective by the settling parties.  For example, if a case had a $100,000 total settlement and a $80,000 MSA, the settling parties would choose to pay a $15,000 payment to Medicare instead of an $80,000 payment to an MSA and this would be detrimental to Medicare.
  2. Any surplus MSA monies at death would not be available to the claimant’s beneficiaries because they were previously paid to Medicare.  This is a big problem for the claimant and the plaintiff attorneys.
  3. The 15% safe harbor forces the claimant to immediately begin paying Medicare deductibles and co-pays, that the Medicare Set-Aside would have otherwise paid, which could be very costly to the claimant.

We believe that there are some positive steps that can be taken in the current MSA program that would make it more efficient for the settling parties, while at the same time, continuing to maintain the goal of the program, which is to protect the Medicare Trust Funds.  We hope to write more about that in a future blog.

To view H.R. 1982 click here.

Medicare Secondary Payer Bill Introduced in U.S. House as H.R. 1982

Yesterday, U.S. Congressmen Dave Reichert (R-WA) and Mike Thompson (D-CA) introduced the Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act (H.R. 1982) in the U.S. House of Representatives.

A full text H.R. 1982 is not yet available.  But, it is believed to be similar to H.R. 5384, which was introduced in the past congressional session but failed to pass.

In a press release issued by Congressman Reichert’s office, H.R. 1982 “establishes clear and consistent standards for an administrative process that provides reasonable protections for injured workers and Medicare”.

We will let you know more details as soon as the full text of the bill is released.

To view Congressman Dave Reichert’s press release about H.R. 1982, click here.

To view our previous post about H.R. 5384, click here.

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President Obama signs the Smart Act as H.R. 1845

Today, President Obama signed the Strengthening Medicare and Repaying Taxpayers (Smart) Act into law as part of H.R. 1845.  This bill represents one of the most significant changes in the Medicare Secondary Payer (MSP) conditional payment recovery process since the MSP Statue was enacted in 1981.

The SMART bill is the result of over four years of effort from the Medicare Advocacy Recovery (MARC) Coalition, which represents virtually every group of stakeholders impacted by the Medicare Secondary Payer (MSP) statute.   The Congressional Budget Office estimated that the SMART Act would save Medicare $45 million from 2013-2022 by making it easier for payers to reimburse Medicare.

The Smart Act amends the Medicare Secondary Payer Statue by adding a new clause at the end of the existing statute that provides for the following:

  • Section 201 – Expedited Repayment, Web Portal and Right of Appeal.  This section requires CMS to maintain and make available a timely updated website so settling parties can determine how much is owed to CMS for conditional payments, during the settlement process.  It also requires CMS to provide a timely appeals process and to promulgate related regulations, if the settling parties believe there is a discrepancy in the conditional payment statement.
  • Section 202 – Threshold.  Establishes that an actuarial single threshold amount be set for exemption from conditional payment reimbursement, where the expected recovery amount is less than the cost to recover.
  • Section 203 – Section 111 Penalties.  Makes the $1,000 per day Mandatory Insurer Reporting (MIR) non-reporting penalty prevision discretionary by changing the statutory language from “shall be subject” to “may be subject to”.   Also, this section requires CMS to publish formal regulations specifying situations where the penalty will not be imposed due to good faith efforts to comply.
  • Section 204 Social Security Number.  Directs CMS to modify the MIR reporting requirements so that reporting of social security numbers are not required.
  • Section 205Statute of Limitations.  Creates a three-year statute of limitations for conditional payment recovery actions brought by the government.

There are many details to follow as CMS promulgates regulations and establishes a Website portal.   We will certainly keep you informed as news develops.

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U.S. Senate Passes SMART Act

This evening, the U.S. Senate passed Smart Act by unanimous consent.

“We are delighted that the Senate has approved the legislation,” said Roy Franco , Co-Chair of MARC, and Chief Legal Officer of Franco Signor , representing the MSP efforts of Safeway. “We particularly appreciate the leadership of Senators Wyden and Portman on this legislation, which will streamline the Medicare process for tens of thousands of Medicare beneficiaries, and will restore millions to the Medicare Trust Fund faster,” he stated.

The U.S. House of Representatives passed the legislation on December 19th.  The Smart Act now goes to the President Obama for signature.

To view the MARC Coalition press release click here.

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U.S. House of Representatives Passes SMART Act

On December 19th, by a vote of 401 to 3, the U.S. House of Representatives, on a motion to suspend the rules, passed the Strengthening Medicare and Repaying Taxpayers (SMART) Act.  The SMART Act was introduced in March 2011 as H.R. 1063 by Dr. Tim Murphy (R-PA) and Ron Kind (D-WI).  In a procedural effort to move the bill to the House floor for a vote, the SMART Act was included in H.R. 1845, dealing with Medicare coverage for in-home intravenous immune globulin (IVIG) treatment.  A motion to suspend the rules is a procedure used by the House to quickly pass non-controversial bills.

The SMART Act has broad bi-partisan support in Congress and wide industry support.   The Medicare Advocacy Recovery Coalition (MARC), which is the main driving force behind the SMART Act claims that the legislation will “significantly improve the efficiency of the current Medicare Secondary Payer (MSP) system and speed repayment of amounts owed from Medicare beneficiary claims directly to the Medicare Trust Fund.”   Specifically, the MARC coalition says that the bill will:

  1. “Require CMS to issue a demand BEFORE a settlement, judgment or award in certain liability claims;
  2. Establish a 3-year statute of limitations
  3. Abolish the use of SSN for Section 111 Reporting
  4. Establish a right of appeal for insurance companies and self-insureds
  5. Soften Section 111 penalties giving HHS discretion when it issues such penalties
  6. Establish annual minimum thresholds for Section 111 reporting, where the cost to HHS is greater than the recovery.”

Medivest strongly supports the SMART Act and congratulates the MARC Coalition for their dedicated efforts to get this bill passed by the House.  The bill will now move over to the Senate for consideration.

To view H.R. 1845 click here.
To view the MARC press release click here.
To view the Congressional Record discussions on H.R. 1845 click here.

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SMART Act Passes Energy and Commerce Health Subcommittee

Yesterday, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act, for short) passed the House Energy and Commerce Subcommittee on Health.  The bill, as amended, passed by unanimous vote.

This is a big step forward, however the bill still has a long way to go before becoming law.  The bill, with amendments, now heads to the Congressional Budget Office for scoring then back to the full Energy and Commerce Committee for a vote.

We will keep you informed and provide you with an analysis of the amendments as soon as that information is released.

To view Congressman Tim Murphy’s September 11, 2012 press release click here.

Recap of H.R. 5284 – The Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act of 2012

The Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act of 2012, H.R. 5284, was filed in the U.S. House of Representatives by Rep. Dave Reichert (R-WA) on April 27, 2012.  The Government Printing Office released the text of the bill today.  Rep. Reichert claims that this bill “improves the Medicare set-aside process for workers compensation claims” and “provides clear and consistent standards for an administrative process that provides reasonable protections for injured workers and Medicare”.

Threshold for MSP Treatment

H.R. 5284 amends the Medicare Secondary Payer (MSP) statute to provide an exemption from the Medicare Secondary Payer (MSP) statute for workers’ compensation settlements where any of the following occur:

  • The total settlement is $25,000 or less
  • The claimant is not eligible for Medicare at settlement date and is unlikely to become eligible for within 30 months
  • The claimant is not eligible for payments of future medical bill under the settlement
  • The settlement agreement does not limit or extinguish the right of the claimant to payment of future medical bills

A “Qualified Medicare Set-Aside”

In addition, this proposed legislation amends the MSP statute to provide that if a workers’ compensation settlement includes a “qualified Medicare set-aside” (QMSA) then that settlement will satisfy any obligation, with respect to present or future payment reimbursement obligation under Section 1395y(b)(2) of the MSP statute.

A (QMSA) is defined in H.R. 5284 as a Medicare set-aside that reasonably takes into account the full payment obligation for present and future medical payments.  It must give due consideration to: the illness or injury, age and life expectancy, the reasonableness of and necessity for future medical expenses, the duration of and limitations on benefits payable under the workers’ compensation law or plan and the relevant State workers’ compensation regulations and case law.  A QMSA must include payment for items and services that are covered by the workers’ compensation law or plan involved.  The QMSA must be based on the applicable workers’ compensation State fee schedule.  A QMSA can be calculated using a proportional adjustment for compromised settlements that reduces the QMSA by the same proportion that the total settlement was reduced.

15% Safe harbor payment

Medicare set-asides of $250,000 or less are deemed QMSAs, only upon written consent of all parties to the settlement agreement, and if a “safe harbor amount” is paid directly to Medicare.  The safe harbor amount is defined as 15% of the total settlement, excluding repayment of conditional payments and previously settled portions of the claim.  The bill gives the Secretary the authority to modify the safe harbor percentage if it is determined that the 15% rate causes significant negative impact.

Approval of Qualified Medicare Set-Asides

H.R. 5284 maintains the current optional CMS review process however it makes some significant changes.  It gives the Secretary 60 days to review the QMSA and failure to meet that 60-day deadline deems the QMSA to be approved.  The Secretary must include specific reasons for any denial.   An appeals process is established, with specific time deadlines, that entitles the dissatisfied party the right to a reconsideration by the Secretary, a hearing before an administrative law judge, and a judicial review.

90 Day Requirement for Conditional Payment Request

If the Secretary fails to provide conditional payment information within 90 days, then neither the claimant nor the payer is liable for any reimbursement to Medicare with respect to the conditional payment information being requested.

QMSA payment greater than payment under workers’ compensation law

No one shall be liable for any payment amount established under a Medicare set-aside for an item or service provided to the claimant that is greater than the related workers’ compensation fee schedule amount.  In addition, a provider may not bill a Medicare set-aside more than the payment rate used in the Medicare set-aside or the Secretary may apply sanctions.

Treatment of state workers’ compensation law

If a workers’ compensation settlement agreement is accepted in accordance with the workers’ compensation law of a jurisdiction, then that acceptance shall be deemed conclusive.  That includes determination of reasonableness of the settlement value, any allocation of funds, the projection of future indemnity or medical benefits that may be payable under State workers’ compensation law.

To view the text of H.R. 5248, click here.

U.S. Representative Dave Reichert Introduces H.R. 5284 to Reform the MSP Process

In a press release dated April 27, 2012, U.S. Representative Dave Reichert (R-WA) announced that he and co-sponsor, U.S. Representative Mike Thompson (D-CA) introduced legislation to be named, “The Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2012″.   The resolution was assigned to the House Ways and Means Committee and the House Energy and Commerce Committee, which will consider it before possibly sending it to the U.S. House or U.S. Senate as a whole.

All indications are that this resolution is going to be similar to H.R. 2641 introduced by Representative John Tanner (D-TN) on May 21, 2009, but the text of H.R. 5284 has not been made public yet so we don’t know the details. We are told that the bill should be made public in the coming days so stay tuned and we will keep you informed.

 

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H.R. 1063, the SMART ACT of 2011, Introduced to amend Medicare Secondary Payer Statute

On March 15, 2011, H.R. 1063, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART ACT) was introduced in the 112th Congress by Congressman Tim Murphy (R-PA) and Congressman Ron Kind (D-WI). This bill is supported by the Medicare Advisory Recovery Coalition (MARC) and is very similar to H.R. 4797 introduced on March 9, 2010.

MARC states that this legislation will, “significantly improve the efficiency of the current Medicare Secondary Payer (MSP) system and speed repayment of amounts owed from Medicare beneficiary claims directly to the Medicare Trust Fund”.

In summary, this bill proposes the following amendments to the Conditional Payments section (42 U.S.C 1395y(b)(2)(B)), the Mandatory Insurer Reporting section (42 U.S.C 1395y(b)(8)), and adds a new section (42 U.S.C 1395y(b)(9)) to the Medicare Secondary Payer Statue:

Section 2 – Expediting Secretarial Determination Of Reimbursement Amount To Improve Program Efficiency

  • First request within 120 days – A claimant or applicable plan can make a request for conditional payment statement within 120 days of a reasonably expected settlement.
  • Response within 65 days – The Secretary* must respond to the request within 65 days of first request.
  • 2nd Request – If the Secretary fails to respond to the first request a second request for conditional payment can be made.
  • Failure to respond within 30 days – If the Secretary doesn’t respond to the second request within 30 days, the responsible parties are not liable to reimburse the Secretary for the conditional payment (with some exceptions to be determined later by regulation)
  • If settlement doesn’t occur – within 120 days, the Secretary is exempt from the time requirements above.
  • Appeal process – The Secretary shall issue regulations establishing a right of an appeals process for the Secretary’s determination of a Conditional Payment amount.

Section 3 – Fiscal Efficiency And Revenue Neutrality

  • Minimum dollar threshold – The Secretary will establish a minimum threshold dollar amount, below which, conditional payment reimbursement and Mandatory Insurer reporting will not be required.
  • Ongoing responsibility for medicals (ORM) – For purposes of computing the minimum dollar threshold and conditional payment reimbursement the payment is defined as only the cumulative value medical payments made and the purchase price of any structured annuity.

Section 4 – Reporting Requirement Safe Harbors

  • $1,000 per day penalty – Changes the terminology used to define MIR violation fines from “shall be subject” to “may be subject”.
  • Good faith exceptions – after enactment of this bill the Secretary must publish “good faith” exceptions to the $1,000 non-reporting penalty after soliciting proposals and public comment.

Section 5 – Use Of Social Security Numbers And Other Identifying Information In Reporting.

  • SSNs not required – Within one year the Secretary shall modify the MIR reporting requirements so that an applicable plan is not required to report a claimant’s social security number.

Section 6 – Statute Of Limitations

  • A 3 year statute of limitations – will apply for conditional payment and MIR actions

*The term “Secretary” in this bill and the current statute refers to the Secretary of the US Department of Health and Human Services (HHS), which oversees its Division of Medicare and Medicaid Services (CMS), which oversees the federal Medicare health insurance program

To view the bill text for H. R. 1063, 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.