Companion Medicare Set Aside Bill Introduced in House of Representatives


8/2/2018

By Marty Cassavoy, Vice President Medicare Secondary Payer Compliance

A new Medicare Set Aside bill was introduced in the House of Representatives on Thursday July 26th.  The bill, which appears to be a companion to a bill previously introduced in the Senate on June 18th, is sponsored by Rep. Dave Reichert (R-WA) and co-sponsored by Rep. Mike Thompson (D-CA).  The text on H.R. 6619 is not yet available however we would anticipate that it is more or less identical to S. 3079.

As a reminder, the Senate version of the bill makes several proposals as follows:

  1. It creates a formal appeals process for Medicare Set Asides where the parties are dissatisfied with Medicare’s future medical recommendation.
  2. It establishes a process whereby the beneficiary could elect to pay Medicare directly rather than administer their Medicare Set Aside.  By paying Medicare directly, the beneficiary could simply utilize his/her Medicare coverage post-settlement.
  3. It requires CMS to acknowledge state workers’ compensation law in its review of any MSA proposal.
  4. It codifies certain details about MSAs that are currently driven by policy, such as use of state workers’ compensation fee schedules where available.
  5. It modernizes language to change the term “workman’s compensation” to “workers’ compensation” throughout the MSP statute.
  6. It creates a process for “compromise settlements” whereby parties could adjust the amount of an MSA downward in direct proportion to the denied components of the underlying workers’ compensation claim.
  7. It confirms that CMS review of an MSA proposal is never required.

We are closely monitoring both pieces of legislation and will provide updates as they materialize. Should you have any questions in the meantime, please contact Marty Cassavoy at 781-517-8085 or marty.cassavoy@examworks-cs.com.

About Marty Cassavoy

Marty Cassavoy is the Vice President of MSP Compliance at ExamWorks Clinical Solutions. Marty and his team develop solutions to challenges in all areas of Medicare Secondary Payer compliance and across all insurance types.  An attorney licensed to practice law in Massachusetts, Marty works in ExamWorks’ Woburn, Massachusetts office and can be reached at 781-517-8085 or marty.cassavoy@examworks-cs.com

  

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