TIP OF THE WEEK

May 31, 2006

Did you know...?

Representative Clay Shaw (R) of Florida proposed major changes to the Medicare Secondary Payer Act (“MSP”) on May 4, 2006 by introducing H.R. 5309, the “Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2006.”  If passed, this bipartisan bill will reform the procedures for workers’ compensation Medicare set-asides.  Some of the changes include:

• The bill carves out exceptions from the MSP, whereby certain settlements need not consider Medicare’s interests in the settlement of workers’ compensation claims. 
• The bill also creates a class of “qualified” Medicare set-asides that protect the claimant and workers’ compensation payer from any recourse by the Centers for Medicare & Medicaid Services.
• The bill creates an administrative process for appealing adverse actions by CMS, including the right to file a request for reconsideration within 60 days after the notice of the adverse determination. 
• The bill allows CMS to serve as an administrator of qualified set-asides. 
• The bill establishes a means by which claimants can obtain a modification or termination of the set-aside upon a showing of “substantial medical improvement, with respect to the injury or illness involved, or of changed circumstances of the claimant that justify a reduction of the funds in the Medicare set-aside…by at least 25 percent” at any time more than five years from the date of a Medicare set-aside. 

HR 5309 was drafted by a coalition, led by the Unemployment &Workers’ Compensation Office (UWC) of Washington, DC, with whom the National Council of Self-Insurers works.  The coalition consists of self-insured employers, workers’ compensation insurance carriers, claimants’ and defense counsel, who are active in workers’ compensation. Click here to learn more about UWC.

To learn more about HR 5309, point your browser to:  http://www.namsap.com/MSPWCSA%20bill.pdf.

To contact your representative to encourage them to vote for HR 5309, point your browser to:  http://www.house.gov/house/MemberWWW.shtml.

To learn more about OHS-COMPCARE, contact our Client Services Team at (816) 561-2105 or by e-mail at customerservice@ohscompcare.com.  You can also visit us at www.ohscompcare.com.

*Please feel free to forward this information to any member of management in your company who would benefit from it.*

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