11-7-11; MEDICARE & SMART ACT UPDATE—As we have been reporting, changes to the Medicare Secondary Payer Statute which should assist in resolving Medicare issues continue to wind through the...
/As previously reported starting in March of this year, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) (H.R. 1063) was introduced in the U.S. House of Representatives and has now moved into the U.S. Senate (S. 1718).
U.S. Senators Ron Wyden (D-Ore.) and Rob Portman (R-Ohio) are joining in a bipartisan effort which includes U.S. Senators Ben Nelson (D-Neb.) and Richard Burr (R-N.C.) to make the Medicare Secondary Payer (MSP) Program more efficient and cost effective to taxpayers and appear to be working off a platform similar to the House proposal. The Strengthening Medicare and Repaying Taxpayers (SMART) Act will hopefully clear a lot of the confusion and speed up the rate by which Medicare and its beneficiaries provide information to applicable parties and it should also speed up the rate in which the Feds are reimbursed for costs that should be borne by another party. The easier repayment process is not just good for Medicare and taxpayers, but also for the beneficiary who should be able to settle their claim more quickly.
Under the MSP program, if a Medicare beneficiary is injured by a third party and a settlement is pursued as a result of that injury, the third party is responsible for paying for the individual’s medical expenses—and as most of us who have been involved with a case in which Medicare arguably has an interest, the process moves slower than molasses in a winter colder than a well-digger’s ankles.
Under current law and procedure, Medicare does not have a way to disclose the MSP amount before settlement, creating unnecessary uncertainty which makes it both difficult and stressful to determine settlement of cases—and also leaves many settlements “open” due to the lack of certainty in being able to address the issues. As a result, unrelated payments may be included, Medicare may spend more money pursuing an MSP payment than they actually end up receiving in payment, sensitive personal information release is necessary causing privacy concerns and since there is no clear statute of limitations on all MSP claims—there is no finality due to the uncertainty.
The SMART Act proposes major amendments to the Medicare Secondary Payer Statute (MSP) including generally
- Require CMS to respond to requests for conditional payment information within set timelines (prior to settlement)—and to provide actual amounts
- Provide MSP appeal rights
- Set MSP threshold exemptions to ensure they are not pursuing claims which are not cost-effective
- Establish alternative methods of to identify individuals to protect sensitive personal information
- Set MSP statute of limitations (proposed as three years for most claims)
We will continue to keep you advised of updates as they occur and as previously noted, Shawn R. Biery has been granted the Medicare Set-aside Consultant Certified (MSCC) credential. Please feel free to contact Shawn R. Biery, J.D., M.S.S.C. at sbiery@keefe-law.com with any questions regarding Medicare Set-Aside issues.