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Medicare Set Aside News - Medicare Secondary Payer and "Future Medicals"

The Centers for Medicare and Medicaid Services (CMS) announces an Advance Notice Of Proposed Rulemaking on 6/15/12.

The Centers for Medicare and Medicaid Services (CMS) have announced in an Alert on June 15, 2012 that the proposed rules for Medicare Set Asides apply to future medicals in general and are not limited to liability as many speculated. There are seven options proposed: 1 – 4 applying to both beneficiaries and those with the "reasonable expectation," and 5 – 7 applying only to beneficiaries. No one option satisfies all possible scenarios; therefore, it is assumed that more than one would be adopted if found to be feasible. The options are as follows:

  1. Total honor system where an individual pays for all related future medical until the settlement is exhausted and the person documents the case accordingly. There would be no CMS review of the Medicare Set Aside but it reserves the right to randomly audit records.
  2. Liability settlements with no Workers Compensation or No-Fault coverage that are at least a year old and essentially resolved will not be pursued by CMS for a Medicare Set Aside.
  3. MSP recovery limited to CPL with physician attestation of no future anticipated treatment. If date of completion is after settlement, future medicals would limited through that date.
  4. Current CMS review program for Medicare Set Asides would be extended to liability settlements.
  5. If beneficiary participates in any of the new recovery options (settlement under $300, fixed payment or self-calculation), future medicals will also be considered satisfied.
  6. Upfront payment options for ORM situations with CMS approval or liability settlements paying a specified percentage of net beneficiary proceeds.
  7. No future obligations in cases where CMS granted compromise or waiver of recovery. All Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers' Compensation Responsible Reporting Entities (RREs) are not required to "Self-Report" Ongoing Responsibility for Medicals (ORM) outside of the MMSEA Section 111 reporting process.

Click here for the New CMS Alert.

Call us for more information about your specific questions related to this important CMS update.

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