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 Webinar: Mastering Mandatory Reporting for Insurance Providers

Mark your calendars! The Centers for Medicare & Medicaid Services (CMS) hosts an essential webinar on Section 111 Non-Group Health Plan (NGHP) Reporting. This event is crucial for those involved in liability insurance (including self-insurance), no-fault insurance, and workers' compensation.

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 Long Legacy of COVID-19 Disability

The legacy of the COVID-19 pandemic persists. There exists a continuing need for long-term treatment and disability. While state benefit systems such as workers’ compensation have made an admirable attempt in many jurisdictions to provide benefits, a significant gap and non-uniform delivery of benefits continue to exist among jurisdictions. Federal efforts are expanding to provide necessary research and treatment protocol resources. 

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.

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.

NJ Supreme Court Reiterates the Liberal Application of Workers' Compensation Act in a Parking Lot Case

The NJ Supreme Court ruled that an employee’s injuries arose out of and in the course of her employment because the parking lot where she was injured was owned and maintained by the employer, adjacent to her place of work, and used by employers’ employees to park. The employee was therefore entitled to benefits under the Workers’ Compensation Act.

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.

Governor Murphy Reinstates Public Health Emergency Triggering Presumptions of Compensability

Governor Phil Murphy today reinstated a Public Health Emergency, effective immediately, in order to ensure that the State is able to respond to the continued threat of COVID-19 and the rapidly spreading Omicron variant. The declaration of a public health emergency by statute triggers the workers’ compensation compensability presumptions for essential workers.

Municipal police officers’ health contribution not based on temporary disability

Municipal police officers' contributions to their health benefits plans could not be based on the rate of their temporary disability benefits. The purpose of workers’ compensation temporary disability benefits is to provide an injured worker with a partial wage to replace wages because of a work-related accident.

Innovation is Necessary to Meet the Challenge of COVID in 2022

COVID is the most extensive occupational exposure event in the history of the United States. Workplaces are now primed for a massive wave of compensation claims due to the Omicron variant. A recent study provides a potential opportunity for employers and insurance companies to reduce their risk exposure through early sequencing and treatment proactively.

New Jersey’s Minimum Wage to Increase to $13/Hour for Most Employees on Jan. 1

New Jersey’s statewide minimum wage will increase by $1 to $13 per hour for most employees, effective January 1, 2022. The increase will be reflected in higher workers’ compensation benefit rates as those are paired with the State Average Weekly Wage (SAWW).

Telehealth Extended for Two Years in New Jersey

Governor Murphy yesterday signed legislation (S-2559-12/21/2021 Approved P.L.2021, c.310) that extends for the next two years the requirement adopted at the outset of the COVID-19 pandemic that health benefits plans reimburse health care providers for telehealth and telemedicine services at the same rate as in-person services, with limited exceptions. 

NJ Workers’ Compensation Benefit Rates Increase in 2022

The New Jersey Department of Labor and Workforce Development (NJDOL) announced increases in the maximum benefit rates for Unemployment Insurance, Temporary Disability Insurance, Family Leave Insurance, and Workers’ Compensation for the calendar year 2022. The increased rates will be effective for new claims dated January 2, 2022, and later.

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.

Despite Potential Savings Most Medicare Part D Participants Don't Switch Plans

Most Medicare Part D participants don't switch plans even though they will save money. "Plan Stickiness" is a common phenomenon Kaiser Family Foundation reports:

Investing for the Next Pandemic

Preparing for the next pandemic is an essential need for all employers, employees, and insurance companies.  The failure of the public health system to handle COVID-19 is evident as the death toll (675,400) fatalities) has now exceeded the 1918 Spanish Flu mortality rate.  The US CDC is encouraging preparation by announcing the opportunity for final investment. It is also incumbent upon the workers’ compensation industry to expand its efforts for pandemic preparation  

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.