Richard L. Gilbert
Richard L. Gilbert is recognized as on of Northern California's premier Mediators and Arbitrators with experience in a wide range of cases and venues.
           


Medicare "Set-Aside Accounts and Related Topics


IMPORTANT CMS ACTION UPDATES

 


June 8, 2016:  CMS has announced that it is considering expanding its "voluntary Medicare Set-Aside Arrangements (MSA)" review to include review of proposed third-party liability insurance (including self-insurance and no-fault insurance) MSA amounts. In an earlier announcement, CMS indicated the potential to include review of third party liability MSA proposals for contractors currently providing that services in the Workers' Compensation arena. (The CMS website post can be found here: (https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Whats-New/Whats-New.html) (Site last checked of June 29, 2016)


 the announcement indicates that CMS plans to work with the "stakeholder community" with regard to implementation of this expansion. Notwithstanding the withdrawal of proposed regulations regarding third-party MSA accounts (see update below) this development, along with other recent guidance, is of great significance.



December 24, 2015: CMS has issued an important policy proclamation having potentially significant impact on third-party liability settlements where future medical expenses for Medicare beneficiaries (current or future) are implicated. Effective January 1, 2016, where an insurer (or workers' compensation entity) reports a settlement involving an obligation to provide ongoing medical care ("ORM"-"Ongoing Responsibility for Medical"), CMS will match reported ICD-9 or ICD 10 codes against future claims to determine if Medicare should pay them. (https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Downloads/Medicare-Claim-Payments-Where-Ongoing-Responsibility-for-Medicals-is-Reported.pdf) While this a policy pronouncement does not immediately and directly implicate lump sum settlements which include a potential amounts allocated to future medical payments, is a significant step in Medicare's utilization of reporting information and emphasizes the need to assure accurate reporting of medical conditions settled in third-party cases. It is inevitable that this matching will apply to a broader range of third-party settlements in the future.


 


October 8, 2014: CMS has withdrawn its proposed rules governing third-party liability MSAs