Hemp, Medicare, and Workers' Compensation

A federal district court in the District of Columbia has dismissed a challenge to a novel Medicare hemp-access program, ruling that the plaintiffs lacked standing to sue. The decision in Smart Approaches to Marijuana v. Kennedy (D.D.C. May 22, 2026) has significant implications for healthcare providers, insurers, and workers' compensation practitioners navigating the rapidly evolving landscape of cannabis-related medical treatment.

Single Payer’s Workers’ Compensation Gamble

For more than a decade, this blog has tracked what I have called “The Path to Federalization,” the steady, incremental expansion of federal authority over what was once an exclusively state-run workers’ compensation system. From the World Trade Center Health Program in 2010 to the Affordable Care Act’s Libby Care pilot, from Supreme Court validation of the individual mandate in 2012 to the Medicare Secondary Payer offset debate, each chapter has added a new stone to that path. California’s 2026 gubernatorial race is laying the boldest stone yet.

SSDI in Freefall

The Social Security Administration's (SSA) Disability Insurance (SSDI) program has undergone a dramatic transformation over the past decade. New data from SSA's Office of the Chief Actuary reveal a steep and sustained decline in disabled-worker beneficiary rolls, a trend with profound consequences not only for disabled workers but also for the workers' compensation system that frequently intersects with SSDI benefits.

Chevron Falls: Workers' Compensation Survives

A year ago, we examined how the Supreme Court's landmark decision in Loper Bright Enterprises v. Raimondo might reshape the workers' compensation landscape, particularly regarding Medicare Set-Aside (MSA) agreements and the Centers for Medicare & Medicaid Services' (CMS) administration of the Medicare Secondary Payer (MSP) Act. Now, with twelve months of hindsight, we can assess what has actually transpired—and what remains uncertain.

WCMSAs: What You Need to Know

The Centers for Medicare & Medicaid Services (CMS) recently hosted an informative webinar on Workers' Compensation Medicare Set-Asides (WCMSAs), shedding light on these crucial financial agreements and their impact on workers' compensation claims. 

Medicare Set-Aside Shake Up Ahead?

Awaiting a decision from the U.S. Supreme Court, Federal Communications Commission v. Consumers' Research is poised to potentially redefine federal administrative agencies' authority scope. This shift could flow into various regulatory processes, including the Workers' Compensation Medicare Set Aside Agreements (WCMSAs) adjudication. 

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 Publishes the Final Rule for MSP Civil Penalties

The Centers for Medicare and Medicaid Services [CMS] has published a final rule specifying how and when CMS must calculate and impose civil money penalties [CMPs] when non-group health plan [NGHP] responsible reporting entities [RRE] fail to meet their Medicare secondary payer [MSP] reporting obligations. NGHP includes workers’ compensation claims. The final rule also establishes CMP amounts and the circumstances under which CMPs will
not or will not be imposed. The effective date of this final rule is December 11, 2023.

Impacts of a Governmental Shutdown

The effects of a government shutdown on state workers' compensation systems and their integration with Social Security will vary depending on the specific circumstances of each state. However, some general trends can be expected.

The Eleventh Circuit Holds 4 Year Statute of Limitations Applies in MSP Private Actions

The 11th Circuit Court of Appeals decided that a four-year statute of limitation applies to private actions pursued under the Medicare Secondary Payer Act [MSPA]. 

Rules Adopted to End NJ Pension Cost Shifting

The New Jersey Department of Labor and Workforce Development [DLWD] adopted Rules embracing the recommendations of  NJ State Comptroller concerning NJ State Pensions. A February 2021 investigative report by the NJ State Comptroller raised critical issues common to other state and national collateral social insurance programs challenged by current fiscal limitations. The rules are effective as of March 7, 2022.  54 N.J.R.448(a). The Rules were adopted without change and have retroactive application.

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.

Rules Proposed to End NJ Pension Cost Shifting

The New Jersey Department of Labor and Workforce Development [DLWD] has proposed Rules that will adopt the recommendations of  NJ State Comptroller. A February 2021 investigative report by the NJ State Comptroller raised critical issues common to other state and national collateral social insurance programs challenged by current fiscal limitations. The deadline for written comments is October 15, 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 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.

Penalty Denied in MSP Private Cause of Action Claim for Delay in Reimbursement

While the personal representative of an estate had standing to bring a lawsuit against a medical provider for recoupment of money under the Medicare Secondary Payer Act [MSP], it was unable to seek double damages for delay in reimbursement of the money paid.

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 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.