The SPARC Act Is Reintroduced to Create MSP Efficiencies

Earlier this year H.R. 1122, the SPARC Act, was reintroduced to assist Medicare Part D drug plans and casualty insurers with coordination of coverages related to the Medicare Secondary Payer (MSP) statute.

On February 16, 2017, the bill’s co-sponsors Representatives Tim Murphy (R-PA) and Ron Kind (D-WI) reintroduced the Secondary Payer Advancement, Rationalization, and Clarification (SPARC) Act in the 115th Congress (2017-2018).

Congressman Murphy stated that “The SPARC Act will increase fairness to beneficiaries, create greater certainty for all settling parties, and avoid wasteful spending by allowing plans to waive secondary payer provisions if costs of recovery exceed the amount to be recovered.” Currently, the MSP law applies to the Medicare Part D program “in the same manner” as it applies to the Part C Medicare Advantage (MA) program. See 42 U.S.C. § 1395w-102(a)(4).

The Act states, “A prescription drug plan shall be secondary payor to any valid and collectible payment from a primary drug plan (as defined in clause (iv)) until such time as such primary drug plan pays a final settlement, judgment, or award to an individual enrolled under the prescription drug plan with regard to an injury or illness involved or otherwise terminates its ongoing responsibility for medical payments with respect to the individual.”

One of the more important aspects of the legislation requires the Centers for Medicare & Medicaid Services (CMS) to coordinate benefits with Part D plans. Currently, CMS is required to provide Section 111 payment information with MA plans within 15 days. Similarly, this legislation would also require CMS to provide Part D plans with information within 15 days. Thereafter, Part D plans would also be required to notify no-fault and workers’ compensation carriers that have accepted an ongoing responsibility to pay a beneficiary’s medical treatments, including prescription drug benefits.

At this time, the bill has been referred to the House of Representatives Subcommittee on Health for further action. For a full copy of the bill, please click here >>