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CMS Withdraws MSP Future Medicals Rule

The Centers for Medicare and Medicaid Services has officially withdrawn their proposed rule on Medicare Secondary Payer: Future Medicals. Many organizations have been actively lobbying against this rule since its introduction in August 2013. Many are happy that a rule which would have left injured people without the benefit of Medicare coverage while seeking legal compensation for their injuries has officially been withdrawn.

Medicare Secondary Payer Provisions

In 1980, Congress enacted laws that made Medicare the secondary payer to certain primary plans. These provisions are known as the Medicare Secondary Payer (MSP) provisions, codified in Section 1862(b) of the Social Security Act. When specific conditions are met, these laws prohibit Medicare from making payment if it has been made or can reasonably be expected to be made by a workers’ compensation law or plan, automobile and liability insurance, or no-fault insurance.

If payment has not been made or cannot reasonably be expected to be made promptly, Medicare is permitted to make conditional payments. A conditional payment means that Medicare pays for medical claims with the expectation that it will be repaid if the beneficiary obtains a settlement when seeking legal compensation for the injuries. If Medicare makes conditional payments, the MSP statute imposes an obligation on the government to recover those conditional payments, after it is established that another individual or entity is responsible for primary payment.

Medicare Future Medicals

The designation future medical care, or future medicals, is used to reference medical items and services provided after the date of any legal settlement. The purpose of the proposed rule was to clarify the guidelines surrounding Medicare’s payment responsibilities for future medical MSP obligations. Currently, workers’ compensation cases are able to use Medicare’s formal “Medicare Set-Aside Arrangement” (MSA) review process in order to determine if a proposed set-aside amount is sufficient to meet their MSP obligations related to future medicals.

As of yet, Medicare has not established a similar process for individuals/beneficiaries to use to meet their MSP obligations with respect to future medicals in liability insurance situations.

Proposed Future Medicals Rule

The proposed rule stated that if an individual or Medicare beneficiary obtains a settlement and has received, reasonably anticipates receiving, or should have reasonably anticipated receiving Medicare covered and otherwise reimbursable items and services after the date of settlement, they will be required to satisfy Medicare’s interest with respect to future medicals related to their settlement.

Response to the Proposed Rule

For more than a year, various lobbying efforts have been made to stop the proposed expansion of MSP’s authority to collect settlement monies from current and future Medicare beneficiaries. Meetings were held with the White House, Centers for Medicare and Medicaid Services, Office of Management and Budget, and Capitol Hill to share concerns about why the proposed rule could have a drastic, serious impacts on vulnerable individuals and their ability to get future medical care after an accident.

On October 8, the Centers for Medicare and Medicaid Services withdrew the Notice of Proposed Rulemaking that it had submitted regarding MSP and future medicals. It is expected that the Centers will redesign the proposed rule and resubmit it at a later date; however, many are celebrating the fact that this version of the rule has been struck down.

Call an Accident Attorney Today

Having the future medicals rule withdrawn means that Medicare and non-Medicare recipients no longer have to worry about paying for medical treatments that they have yet to receive. If you or a loved one has been injured in an accident in West Palm Beach or the surrounding area, let the attorneys at Gary Roberts & Associates help. Call or contact the office today for a free and confidential consultation of your case.

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