The meeting of the 111th Congress was the one that saw Medicare Secondary Payer bill H.R. 2641 flop over and twitch. The 110th saw that happen to H.R. 2549 also, and H.R. 5309 went the same way during the 109th. In case you don't recall this particular bill in all its iterations, it addressed Medicare Set-Asides ("MSAs") for workers' compensation.
Now it's reanimated in the form of H.R. 5284, which
was introduced by Congressmen David Reichart (R-Washington) and Mike Thompson
(D-California) on April 27th. The bill seeks to amend the Social
Security Act, specifically section 1862. If you're not familiar with that
particular section, it's the one that deals with Medicare's secondary payer
rules and set-asides with regard to workers' compensation settlement
agreements. It's the essentially the
same bill that was proposed to the three previous Congresses -all of which died
in committee-- and it was called by the
same name which is assigned to it now: The Medicare Secondary Payer and Workers'
Compensation Settlement Agreements Act. This time, however, it will have the
phrase 'of 2012' behind it.
Don't know much about all this? Well, in short, Medicare requires that a trust fund be established in cases where injured workers will become eligible for Medicare during their claim period. The funds are set aside as a stopgap for Medicare spending; this is to help conserve the resources of an already-overburdened Medicare system.
There is a catch, though: The Centers for Medicare and Medicaid Services (CMS) must approve any set-asides for trusts exceeding $25,000 before a claim can be closed. CMS has been roundly criticized for the length of time that it takes to review and approve those trusts, for the lack of consistency in its review standards for trust amounts, and for its lack of a process by which decisions can be appealed. H.R. 5284 aims to resolve delays and introduce consistent standards into the CMS set-asides process.
The Government Accountability Office (GAO) released
a report
on these problems in March of this year. According to the GAO, the
average
processing time for set-aside proposals went from 22 days in April 2010
up to
95 days in September 2011, which of course delayed case resolutions (CMS
officials stated that they'd like to be able to wrap up reviews in 45
days). The
report further stated that a backlog was created by a marked increase in
submissions from 2008 to 2011, along with a change in the data system
that
slowed the process overall. It was noted that submissions that were
ineligible altogether jumped in number significantly (by 148 percent)
and this created a further backlog.
"This is a much-needed 'common sense' reform to ensure that Medicare claims are handled in a way that is more efficient so that the parties involved can move forward swiftly and with certainty to protect injured workers," said Congressman Reichert. "Our bill gives injured workers the confidence that their health care claims will be processed in a fair and timely way."
You can see the full text of the bill in PDF format here. It will be interesting to see whether or not it suffers the same fate as its predecessors.
MSAs can be confusing when questions arise regarding when they are (or aren't) required. For additional clarification about how MSAs can affect your workers' compensation settlement in Georgia, contact Moebes Law, LLC at 404-354-5432.
After waiting 11 years to come to an agreement then have this go to a seperate goverment agency that has had my husbands case now for over 120 days, I have seen no where that it is supposed to be taking this long. We need accurate answers from people processing these forms. Was told today May 24, 2012 that they are working on cases from September 2011 this puts it at 240 days about 175 longer than they are stating. What is really going on and they really should hire more people instead of delaying these cases any further!! Also the person answering the phone should beable to give a time frame instead of telling people wait until the end of the Myan Calendar, that will be over 1 year for this case to be reviewed by CMS. This is wrong and needs to be changed.