Pending Legislation May Amend the Medicare Secondary Payer Act H.R. 1982 was introduced in Congress earlier this year. Proposed are amendments to the Secondary Payer Act section of the Social Security Act. If enacted, the amendments would serve to: 1. Set forth criteria for Medicare’s review of set-aside proposals. Set-aside arrangements would not need to be submitted to Medicare if below the $25,000 threshold, if the claimant will not become eligible for Medicare within 30 months on the date settlement is finalized, or if the agreement does not extinguish the employer’s liability for medical expenses. The amendments further define when a claimant is unlikely to become Medicare eligible. 2. Provide guidance for the computation of when a settlement agreement meets the “$25,000 or less” threshold. Included in the calculation are wage loss benefits, repayment of Medicare conditional payments, attorney fees, payment for future medical expenses, annuity funding, and any funds previously provided toward settlement of any portion of the workers’ compensation claim. 3. Establishes a “Safe-harbor” option. This option would allow the parties to make a direct payment of 15% of the total settlement amount directly to Medicare, thereby satisfying the parties’ obligations to Medicare. The Secretary of Health and Human Services will have the right to make a determination after three years whether this section has caused a significant negative financial impact on Federal funds and, if so, can create rules to modify this section accordingly. 4. Enable parties to appeal Medicare’s determinations. A request for reconsideration would be considered by the Secretary of HHS, could then be appealed to an ALJ, and then be further appealed to Federal District Court. 5. Allow the parties to a workers compensation settlement to make payment of a set-aside directly to Medicare. 6. Assure the parties that settlements meeting the terms of Federal statute at the time of the settlement will be accepted despite later changes in the law. Further information, including the full text of the bill, can be found here: beta.congress.gov/bill/113th/house-bill/1982/text. Let us know your opinions regarding the proposed changes.
Posted on: Thu, 12 Sep 2013 19:57:45 +0000
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