Urges Amendment of the Medicare Secondary Payer Act
RESOLVED, That the American Bar Association urges Congress to amend acknowledge that there is no regulatory or statutory basis for Medical Set Asides for third party liability settlements, judgments or awards under the Medicare Secondary Payer Act to and provide clear, predictable, and consistent procedures for the submission, uniform determination, and timely approval of any third party medical set aside settlement proposals (MSASP) voluntarily submitted to the Centers for Medicare & Medicaid Services (CMS) in response to the non-binding recommendations of CMS.
FURTHER RESOLVED, that legislation to accomplish these goals should incorporate the following principles:
1. Acknowledge that there are not statutory and regulatory requirements for determining Medical Set Aside payments and the process for approving claims subject to the Medicare Secondary Payer Act for third party liability claims.
2. Exempt from review by CMS all settlements in which there are no legal obligations to pay medical benefits.
3. Establish an appeals process that must be completed by CMS within 690 days of request by the claimant, insurer, or their representative.
4. Prohibit CMS from seeking additional moneys from the settlement proceeds after review and/or appeals processes have been concluded.
5. Prohibit recovery thresholds for MSASP that are linked to predetermined economic indices.
6. Establish a statute of limitations for MSP claims.
7. Establish a 30 day deadline by which CMS must respond in writing of its acceptance of the proposed MSASP.
8. Require CMS to timely (“timely” means within 60 days the information must be delivered to the patient and patient’s lawyers) and reasonably provide a detailed list of any payments it made and/or may make a claim for set aside for, and if it does not, cannot collect or require a set aside for that patient.
9. Prohibit the “certification” or claim of specialization by any private individual or person or government entity of a process, practice or individual in the determination of MSASP.
10. Prohibit the use of Social Security numbers and Health Card Numbers in the MSASP reporting process.
RESOLVED, That the American Bar Association urges Congress to amend acknowledge that there is no regulatory or statutory basis for Medical Set Asides for third party liability settlements, judgments or awards under the Medicare Secondary Payer Act to and provide clear, predictable, and consistent procedures for the submission, uniform determination, and timely approval of any third party medical set aside settlement proposals (MSASP) voluntarily submitted to the Centers for Medicare & Medicaid Services (CMS) in response to the non-binding recommendations of CMS.
FURTHER RESOLVED, that legislation to accomplish these goals should incorporate the following principles:
1. Acknowledge that there are not statutory and regulatory requirements for determining Medical Set Aside payments and the process for approving claims subject to the Medicare Secondary Payer Act for third party liability claims.
2. Exempt from review by CMS all settlements in which there are no legal obligations to pay medical benefits.
3. Establish an appeals process that must be completed by CMS within 690 days of request by the claimant, insurer, or their representative.
4. Prohibit CMS from seeking additional moneys from the settlement proceeds after review and/or appeals processes have been concluded.
5. Prohibit recovery thresholds for MSASP that are linked to predetermined economic indices.
6. Establish a statute of limitations for MSP claims.
7. Establish a 30 day deadline by which CMS must respond in writing of its acceptance of the proposed MSASP.
8. Require CMS to timely (“timely” means within 60 days the information must be delivered to the patient and patient’s lawyers) and reasonably provide a detailed list of any payments it made and/or may make a claim for set aside for, and if it does not, cannot collect or require a set aside for that patient.
9. Prohibit the “certification” or claim of specialization by any private individual or person or government entity of a process, practice or individual in the determination of MSASP.
10. Prohibit the use of Social Security numbers and Health Card Numbers in the MSASP reporting process.
