Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.
By Sara Hansard
Oct. 14 — A proposed rule that was expected to outline how Medicare's interest should be protected in cases of settlements for future medical care was withdrawn Oct. 8 by the Office of Management and Budget.
The Medicare Secondary Payer and “Future Medicals” proposed rule (CMS-6047-P) “would announce CMS'[s] intention regarding means beneficiaries or their representatives may use to protect Medicare's interest with respect to Medicare Secondary Payer (MSP) claims involving automobile and liability insurance (including self-insurance), no-fault insurance, and workers' compensation where future medical care is claimed or the settlement, judgment, award, or other payment releases (or has the effect of releasing) claims for future medical care,” the abstract on the proposed rule said.
In June 2012, the CMS issued an advance notice of proposed rulemaking (CMS-6047-ANPRM) under which Medicare would not pursue reimbursements from beneficiaries who receive awards from liability insurance under conditions it outlined.
In an Oct. 10 client alert, the Garretson Resolution Group (GRG), which works with personal injury claims settlements, said, “The NPRM was expected to outline how Medicare's interest should be protected (per the Medicare Secondary Payer Act [42 U.S.C. § 1395y(b)(2)]) in cases where future medical care is claimed or effectively released in the settlement, judgment, award, or other payment of damages.”
The alert continued: “While CMS has guidelines in place for the handling of future medical expenses in workers' compensation cases, until final rules are released in the liability context, there are no similar standards for claims involving self-insureds and automobile, liability, and no fault coverage.”
The GRG met with government officials as part of the public comment process for the advance notice of proposed rulemaking in July, the client alert said.
“We stressed the importance that any future medicals rule proposed by CMS, which creates requirements for addressing future costs of care in liability settlements, judgments or other payments, must have clarity for all stakeholders; including which stakeholders are responsible to ensure Medicare remains a secondary payer for Medicare covered, injury-related future medical expenses arising from settlements, etc. Absent such clarity, we strongly recommended that the proposed rules be returned to CMS until such clarity could be obtained,” the client alert said.
“We fully expect CMS to redesign the NPRM and resubmit to OMB at a later date,” the client alert said. “The upcoming guidelines are expected to pinpoint the circumstances in which and the actions settling parties should take to ensure that Medicare remains a secondary payer post-settlement. In the meantime, the withdrawal of the NPRM does not change the analysis in how best to deal with future cost of care questions arising in liability settlements.”
Facts should be reviewed in each case, including whether a settlement pays for injury-related future costs of care that would otherwise be covered by Medicare, it said.
To contact the reporter on this story: Sara Hansard in Washington at email@example.com
To contact the editor responsible for this story: Janey Cohen at firstname.lastname@example.org
The OMB notice of withdrawal of the Medicare Secondary Payer and “Future Medicals” proposed rule (CMS-6047-P) is at http://www.reginfo.gov/public/do/eoDetails?rrid=123255.
The client alert from the Garretson Resolution Group is at http://www.garretsongroup.com/learning-resource-center/client-alerts.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)