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CMS has withdrawn its proposed rules governing third-party liability MSAs