Chevron's Fall: Medicare Set-Asides Face Legal Shake-Up

The recent U.S. Supreme Court decision in Loper Bright Enterprises v. Raimondo (2024), which overturned the Chevron doctrine established in Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc., is likely to have significant impacts on how the Centers for Medicare & Medicaid Services (CMS) operates regarding the Medicare Secondary Payer (MSP) Act, including conditional payments and Medicare Set-Aside (MSA) agreements. 

CMS Expands Options for Defense Submissions for CRCP

Commercial Repayment Center Portal (CRCP) Defense Submission Frequently Asked Questions

Recently a change was made to the portal that allows CRCP users to associate defenses to the individual claims included in recovery demands. This more granular response to demands, where Group Health Plans (GHPs) specify the basis of defense submissions, allows for more efficient and accurate reviews of the submitted defenses. What follows are answers to frequently asked questions received by the Commercial Repayment Center (CRC) in regard to this change. Additional details on the functionality are available in Version 3.2 of the CRCP User Guide, which is available in the “Reference Materials” section of the CRCP.

CMS Health Care Workers Vaccination Deadline March 15, 2022

The Centers for Medicare and Medicaid Services (CMS) issued guidance that the full vaccination compliance deadline is March 15, 2022, for all health care workers subject to the Omnibus Health Care Staff Vaccination rule.

CMS Announces 2022 Workers' Compensation Recovery Threshold to Remain at $750.00

Computation of Annual Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers' Compensation Settlements, Judgments, Awards, or Other Payments for 2022 were announced this week.

CMS stopped from imposing vaccine mandate

The Centers for Medicare and Medicaid Services [CMS] has been halted from imposing a vaccine mandate on a wide range of healthcare facilities. A federal court in Missouri found in favor of a group of 11 Republican states when it issued an injunction against the proposed rule.

CMS Webinar on the PAID Act

To implement the  Provide Accurate Information Directly (PAID) Act*, enacted December. 11, 2020 the Centers for Medicare and Medicaid Services has scheduled a webinar. The program will stream on Wednesday, June 21, 2021.

Investigative Report Raises Issues

The tension between public pension systems and workers' compensation programs was highlighted in a recent investigative report by the NJ State Comptroller. The report raises additional critical issues common to other state and national collateral social insurance programs challenged by current fiscal limitations.

CMS Cannot Seek Reimbursement from Insurance Guarantee Fund

The US 9th Circuit Court of Appeals has ruled that The Centers for Medicare and Medicaid [CMS] cannot not seek reimbursement from from the California Insurance Guarantee Association for workers' compensation payments.

Trump Administration Proposes Elimination of the Reverse Offset

The Trump Administration in its proposed FY 2020 Budget has proposed elimination of the workers’ compensation reverse offset. The elimination will act as a cost saving measure and will level the playing field for all workers’ compensation system throughout the United States.

CMS has scheduled another webinar for Wed., Sept 19, 2018

Commercial Repayment Center Portal (CRCP) Overview Webinar Wednesday, September 19 th, 2018 CMS will be hosting a webinar to present an overview of the Commercial Repayment Center Portal (CRCP) functions.

Medical Fees: Does One Price Fit All?

The Federal government has proposed a simplified medical billing process that may impact workers' compensation billing practices going forward. Most workers' compensation fee medical fee schedules are linked either directly and indirectly the to Federal Medicare model and a proposed Rule published last week in the Federal Register proposes a single fee for all office visits.

NJ Mandates Reporting of Medicare Conditional Payments

The NJ Division of Workers’ Compensation has now mandated the reporting of pending workers’ compensation claims possibly eligible for reimbursement of conditional medical payments to the US Centers for Medicare and Medicare Services  (CMS) as a condition precedent to the settlement of a pending claim for benefits.  The directive was outlined in a memorandum issued by Russell Wojtenko, Jr., Director and Chief Judge of Compensation on April 18, 2018.

Just Published: 2018 Update - Gelman on Workers' Compensation Law

Jon Gelman’s newly revised and updated 2018 treatise on Workers’ Compensation Law is now available from by West Group of Egan, MN within the next few weeks. The treatise is the most complete work available on NJ Workers’ Compensation law and integrated with WESTLAW™, the "most preferred online legal research service.'"

CMS to Host Webinar: Commercial Repayment Center Contractor Transition

Commercial Repayment Center Contractor Transition Webinar for Non-Group Health Plans on Thursday, January 18, 2018 

Effective February 8, 2018, a new contractor will assume the responsibility of the Medicare Commercial Repayment Center (CRC) functions.

Governor of Nevada Vetoes Single-Payer Legislation

Nevada Governor Brian Sandoval has vetoed legislation that would have established a single-payer Assembly Bill 374 would have expanded a Medicare-type health care insurance plan. coverage to provide health care coverage to all Nevada residents.

CMS Prohibited From Collecting for Unrelated Conditions

A Federal Court in California has prohibited the Center for Medicare and Medicaid Services (CMS) from seeking reimbursement of conditional payments when the medical codes for the conditions are unrelated or not related even if the primary code was for a work-related medical condition. The court made the following ruling in a motion for partial summary judgment in a declaratory judgment action.

The limits on a total permanent disability award

The New Jersey Supreme Court recently heard oral argument concerning the mathematical limits of a workers’ compensation total disability case. At the heart of the case is the issue of whether an injured worker could have an increase in a pre-existing permanent partial disability [PPT] claim, that existed prior to the last compensable injury which was to another part of the body. The last compensable claim rendered the worker totally and permanently disabled.

The Consequences of TrumpMedical 2016–25: Price Increases, Aging Push Sector To 20 Percent Of Economy

Workers' Compensation medical expenses mirror some of the national health care projections. An aging workforce and the increased longevity of the population impacts overall all costs. Furthermore as the Affordable Healthcare Act's repeal has been anticipated by the Republican Administration, medical care costs are anticipated to spiral. The draft release of the Republican proposal for a new national medical care system is now being revealed.

Directly and indirectly, workers' compensation coverage will feel the impact. For chronic condition denials, pre-existing condition denials and occupational disease denials, the safety net of Medicaid will be diminished and the workers' compensation system will again be the primary target for payment and litigation will increase logarithmically.

Judge Accepts Medicare’s Plan To Remedy Misunderstanding On Therapy Coverage

Today's post is shared from Kaiser Health News khn.org

"A federal judge has accepted Medicare’s plans to try once more to correct a commonly held misconception that beneficiaries’ are eligible for coverage for physical and occupational therapy and other skilled care only if their health is improving.

"'Confusion over the Improvement Standard persists,' wrote U.S. District Court Chief Judge Christina Reiss in Vermont in a decision released by the court Thursday. Advocates for seniors say coverage is often mistakenly denied simply because the beneficiary reaches “a plateau” and is no longer making progress.

CMS Town Hall Conference - Coordination of Benefits & Recovery for Liability Insurance (including Self-Insurance), NoFault Insurance and Workers’ Compensation

Town Hall Teleconference– November 17, 2016 
Coordination of Benefits & Recovery for Liability Insurance (including Self-Insurance), NoFault Insurance and Workers’ Compensation

On November 17, 2016, CMS will host a teleconference to connect with stakeholders and provide status updates. CMS expects to discuss the following topics:

• Ongoing Responsibility for Medicals (ORM) recovery, 
• Final Conditional Payment (CP) process reminders, 
• Medicare Secondary Payer Recovery Portal (MSPRP) improvements.