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Taransky v. Sebelius, Civil Action No. 12-4437, 2013 WL 3892360 (D. NJ 2013) June 13, 2013
Showing posts sorted by relevance for query MSP. Sort by date Show all posts
Showing posts sorted by relevance for query MSP. Sort by date Show all posts
Wednesday, July 31, 2013
Liability Claim Collateral Source Payments Subject to MSP
Medicare is not required to abide by a stipulated order of allocation of benefits in a liability case when seeking reimbursement under the Medicare Secondary Payer Act (MSP). Also, the New Jersey Collateral Source Statute (“NJCSS”)did not apply to MSP reimbursement claims and collateral proceeds were reimbursable.
" For the reasons described above, the Court concludes that it lacks subject matter jurisdiction over Ms. Taransky's “due process” and “proportionality” claims, as Ms. Taransky failed to administratively exhaust these claims. Additionally, the Court concludes that there is substantial evidence in the record supporting the MAC's properly-reasoned conclusion that in obtaining a tort settlement in a trip-and-fall accident, and notwithstanding a state trial court's order allocating this tort settlement recovery to non-medical expenses, Ms. Taransky received payment from a “primary plan” responsible for payment of her medical expenses that had been covered by Medicare. As a result, Ms. Taransky is required to reimburse Medicare $10,121.15 pursuant to the MSP."
Taransky v. Sebelius, Civil Action No. 12-4437, 2013 WL 3892360 (D. NJ 2013) June 13, 2013
Taransky v. Sebelius, Civil Action No. 12-4437, 2013 WL 3892360 (D. NJ 2013) June 13, 2013
Friday, November 19, 2010
US Seeks to Amend Complaint in Reimbursement Action to Define SOL
The Centers for Medicare and Medicaid Services (CMS) has filed a Motion to Amend its complaint in a lawsuit that will define the Statute of Limitations in a Medicare Secondary Payer (MSP) recovery action. The action by CMS followed the Court granting CMS's Motion for Reconsideration in order to clarify the alleged $25 Million continuing accrual claim.
The Motion pleads, "Although the United States contends that it has set forth sufficient facts alleging its cause of action, the amendments set forth with more specificity (1) the Defendants’ payment of and receipt of annual payments made and received through 2013 as a result of the Abernathy Settlement Agreement, (2) their liability under the MSP Statute stemming from the annual payments, (3) additional information concerning the identified Medicare beneficiaries among the Abernathy Plaintiffs, (4) changes to certain allegations based on facts included in Court filings, and (5) the removal of The Cody Law Firm as a defendant."
The Motion pleads, "Although the United States contends that it has set forth sufficient facts alleging its cause of action, the amendments set forth with more specificity (1) the Defendants’ payment of and receipt of annual payments made and received through 2013 as a result of the Abernathy Settlement Agreement, (2) their liability under the MSP Statute stemming from the annual payments, (3) additional information concerning the identified Medicare beneficiaries among the Abernathy Plaintiffs, (4) changes to certain allegations based on facts included in Court filings, and (5) the removal of The Cody Law Firm as a defendant."
CMS alleges that the parties knew of the outstanding conditional payments made by CMS and failed to reimburse the payments under the MSP Act.
USA v. Strickler, et al., Civil Action No. 1:09-cv- 02423-KOB (USDCT ND Alabama) Filed 11/16/10
Sunday, November 19, 2023
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.
Saturday, October 22, 2011
Government Appeals Case Involving MSP Statute of Limitations
The case was tried in the U.S. District Court, Northern District of Alabama (Eastern) before Judge Karon O. Bowdre and involved a contract reimbursement claim under the Medicare Act, specifically 425 USC 1395 (HHS). A Final Order was entered on September 13, 2011 the the United States filed a Notice of Appeal on October 11, 2011.
Read the prior posting: CMS Has 6 Year Statute of Limitations-Court Dismisses MSP Recovery Claim 10.1.2010
United States of America v James J. Stricker, et al., CV 09-BE-2423-E (USDCT ND Alabama)
Saturday, January 19, 2013
Beneficiary Not Permitted Injunctive Relief From EIRSA Plan Invoking MSP Terms
A Federal Court held that a beneficiary was unable to seek injunctive relief against an EIRSA plan, where the beneficiary sought to have the ERISA Plan action to declare Medicare the primary plan and subject to the Medicare Secondary Payer Act (MSP). The ERISA plan was held to have the right to changes the terms of the plan in order to align the UNICare Benefits of Choice Program with federal law.
The court declared the MSP action alleged in the complaint moot as it granted the motion to dismiss on the injunctive relief issue. The plaintiff/beneficiary sought to allege a private cause of action for double damages against "those of any entity contractually obliged to pay for an individual’s primary health care" The Court held, "....the plaintiff is not attempting to collect damages for medical bills improperly paid by Medicare on his behalf, but instead seeks an injunction requiring Unilever to pay for future medical expenses. No court has allowed a claim for injunctive relief under § 1395y(b)(3)(A) and I am persuaded that such a claim is not authorized by the statute." Im a footnote the indicated, "The government may be authorized to seek declaratory and injunctive relief under § 1395y (b)(2)(B)(iii). See United States v. Baxter Int'l, Inc., 345 F.3d 866, 909 (11th Cir.2003)."
PACHALY v. BENEFITS ADMINISTRATION COMMITTEE UNILEVER UNITED STATES INC. et al., 2913 WK 172993 (DC CT 2013) Decided Jan. 16, 2013
Wednesday, October 9, 2013
Federal Court Deems CMS Interpretation of the MSP Act Impenetrable
A UD District Court has denied a health provider's challenge to CMS's interpretation of the to the Medicare Secondary Act. CMS's formula for reimbursement was upheld.
"The Court finds this line of argument unpersuasive for several reasons. Most significantly, Allina's heavy reliance on the above-cited cases is unavailing because none of those decisions directly dealt with the precise issue before this Court–i.e., the phrase “entitled to benefits under Part A.” Rather, all of those courts were called upon to interpret the other component of the Medicaid fraction's numerator–the requirement that patients be “eligible” for Medicaid. For this very reason, our Court of Appeals “declined to follow” those same cases, characterizing those courts' discussion of the phrase “entitled to benefits” as dicta. Northeast Hosp., 657 F.3d at 12 n.7. This Court agrees with that assessment and follows the lead of our Circuit. Those decisions do not lend any meaningful support to Allina's arguments here. Moreover, the D.C. Circuit has rejected the substance of this “eligible” versus “entitled” argument as unpersuasive in any event, observing in Northeast Hospital that “the fact that the DSH factions speak of ‘eligibility’ for Medicaid but ‘entitlement’ to Medicare” was not “enlightening.” Id. at 12. Instead, as the Circuit went on to state, “the Secretary's interpretation of ‘entitled’ as ‘meeting the statutory criteria for entitlement’ ... does not actually collapse the terms.” Id. (explaining that an individual could be “ ‘eligible’ for, but not ‘entitled’ to, Part A benefits because one has not yet ‘enrolled’ in the program”). This Court concurs. The Secretary's reading of the statute at issue here does not equate these two terms, and Allina's insistence otherwise lacks merit."
"The Court finds this line of argument unpersuasive for several reasons. Most significantly, Allina's heavy reliance on the above-cited cases is unavailing because none of those decisions directly dealt with the precise issue before this Court–i.e., the phrase “entitled to benefits under Part A.” Rather, all of those courts were called upon to interpret the other component of the Medicaid fraction's numerator–the requirement that patients be “eligible” for Medicaid. For this very reason, our Court of Appeals “declined to follow” those same cases, characterizing those courts' discussion of the phrase “entitled to benefits” as dicta. Northeast Hosp., 657 F.3d at 12 n.7. This Court agrees with that assessment and follows the lead of our Circuit. Those decisions do not lend any meaningful support to Allina's arguments here. Moreover, the D.C. Circuit has rejected the substance of this “eligible” versus “entitled” argument as unpersuasive in any event, observing in Northeast Hospital that “the fact that the DSH factions speak of ‘eligibility’ for Medicaid but ‘entitlement’ to Medicare” was not “enlightening.” Id. at 12. Instead, as the Circuit went on to state, “the Secretary's interpretation of ‘entitled’ as ‘meeting the statutory criteria for entitlement’ ... does not actually collapse the terms.” Id. (explaining that an individual could be “ ‘eligible’ for, but not ‘entitled’ to, Part A benefits because one has not yet ‘enrolled’ in the program”). This Court concurs. The Secretary's reading of the statute at issue here does not equate these two terms, and Allina's insistence otherwise lacks merit."
Allina Health System v. Sebelius,
--- F.Supp.2d ----, 2013 WL 5530609, D.D.C., October 08, 2013 (NO. 09-CV-1889 (RLW))
Monday, December 5, 2011
US Supreme Court Maybe Asked to Rule on CMS Issue: "The Doctrine of Equitable Allocation"
I reported on this case last week:
The Doctrine of Equitable Allocation Not Applicable in a Medicare Secondary Payment Reimbursement Claim
A recent news report indicates that appeal maybe sought to the US Supreme Court.
Medicare payment ruling may hinder workers comp settlements
"A federal appeals court decision that allows Medicare to claim nearly half of a man's liability settlement could hinder insurers' ability to settle such claims and may be an issue that reaches the U.S. Supreme Court."
Monday, April 30, 2018
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.
Wednesday, August 5, 2015
CMS to Speed-Up MSP Collection Practices
The Centers for Medicare and Medicaid Services (CMS) has announced that it intends to speed up its collections practices enforcing the Medicare Secondary Payer Act (MSP). CMS stated that such procedures are mandatory under the Digital Accountability and Transparency Act of 2014 or the DATA Act Public Law No: 113-101 (05/09/2014).
Friday, October 1, 2010
Medicare Denied Reimbursement From Claim Of Survivor: Held Separate & Distinct
The 11th Circuit Court of Appeals has held that Medicare is not entitled to reimbursement under the Medicare Secondary Payer Act (MSP) when the the surviving children's allocated share of proceed is the result of a wrongful death claim. The Court reasoned that under Florida law, any claim of the estate is separate and distinct from the claim of a survivor. Under Florida law, child's loss of parental companionship claim is a property right belonging to the child.
Medicare through the Secretary of Health and Human Services (HHS) did not participate in the Florida probate action. HHS had refused to recognize the validity of that decision of allocation of the Florida Probate action.
"Counsel for the survivors and the estate acted sensibly, in a cost-effective manner. The nursing home neglect claim was settled for the full value of the available insurance. Clearly, if the language of the field manual applied, in practice, it would lead to an absurd Catch-22 result. Forcing counsel to file a lawsuit would incur additional costs, further diminishing the already paltry sum available for settlement. This flies in the face of judicial and public policy.
"The Secretary's position would have a chilling effect on settlement. The Secretary's position compels plaintiffs to force their tort claims to trial, burdening the court system. It is a financial disincentive to accept otherwise reasonable settlement offers. It would allow tortfeasors to escape responsibility.
"Without citing any statutory authority, regulatory authority, or case law authority, the Secretary and the district court's reliance upon language in a field manual is unpersuasive. The Secretary is not entitled to any share of the Burke surviving children's loss of parental companionship claims.
The decision may have a sweeping national impact on workers' compensation dependency claims, as they are also separate and distinct actions against an employer.
Bradley v, Sebelius, 621 F. 3d 1330, 2010 WL 3769132 (C.A. 11 Fla. 2010)
For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.
Related Articles:
CMS/MSP Statute Tolling Case Set for Hearing by Federal Court
Monday, September 23, 2013
CMS Publishes Rules to MSP Payments Under the SMART Act
Medicare has published proposed Rules to governor obtaining information concerning the conditional payments as required by the recently implemented SMART Act. The Regulations expand the bureaucratic framework for Medicare beneficiaries and their representatives in order to obtain and appeal information on condition payment demands from the government.
The Rules are effective on November 10, 2013 and the comment period closes at 5pm on that date.
The government will be establishing a multifactorial implementation process to keep information secure: DX Codes, provider names. dates of service and conditional payment amounts. Ultimately, it appears that the process will be yet another hurdle to obtain information for workers' compensation claims and release the beneficiary from government liability for medical expenses.
The proposed CMS Rules can be reviewed at: https://www.federalregister.gov/articles/2013/09/20/2013-22934/medicare-program-obtaining-final-medicare-secondary-payer-conditional-payment-amounts-via-web-portal
The Rules are effective on November 10, 2013 and the comment period closes at 5pm on that date.
The government will be establishing a multifactorial implementation process to keep information secure: DX Codes, provider names. dates of service and conditional payment amounts. Ultimately, it appears that the process will be yet another hurdle to obtain information for workers' compensation claims and release the beneficiary from government liability for medical expenses.
The proposed CMS Rules can be reviewed at: https://www.federalregister.gov/articles/2013/09/20/2013-22934/medicare-program-obtaining-final-medicare-secondary-payer-conditional-payment-amounts-via-web-portal
….
Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
Related articles
- US Supreme Court Asked to Review MSP Preemption Issue (workers-compensation.blogspot.com)
- 9th Circuit Vacates MSP Injunction Against CMS for Medicare Reimbursement (workers-compensation.blogspot.com)
- Medicare To Punish 2,225 Hospitals For Excess Readmissions (workers-compensation.blogspot.com)
- The Public and the Conflict over Future Medicare Spending (workers-compensation.blogspot.com)
- Democrats Jump on the 'Death Panel' Bandwagon (workers-compensation.blogspot.com)
Saturday, June 28, 2014
The Complexity of Medicare
While holding the for CMS (The Centers for Medicare and Medicaid Services) the complexity of the reimbursement of the Medicare Secondary Payer Act was recognized by a Federal Court:
"In re Avandia Mktg., 685 F.3d 353, 365 (3d Cir.2012); The Fourth Circuit has described the Medicare statute as “among the most completely impenetrable texts within human experience.” Rehab. Ass'n v. Kozlowski, 42 F.3d 1444, 1450 (4th Cir.1994). Other courts of appeal, including the District of Columbia Circuit, have echoed this assessment. See Abraham Lincoln Mem. Hosp. v. Sebelius, 698 F.3d 536, 540–41 (7th east Hosp. Corp. v. Sebelius, 657 F.3d 1, 13 (D.C. Cir.2011); Alhambra Hosp. v. Thompson, 259 F.3d 1071, 1076 (9th Cir.2001). For a more literary-flavored spin, consider Judge Lamberth's recent characterization of the statute as akin to “a law written by James Joyce and edited by E.E. Cummings.” Catholic Health Initiatives–Iowa, Corp. v. Sebelius, 841 F.Supp.2d 270, 271 (D.D.C.2012), rev'd, 718 F.3d 914 (D.C. Cir.2013).
Allina Health System v. Kathleen Sebelius, 982 F.Supp.2d 1 (DCT DC 2013)
"In re Avandia Mktg., 685 F.3d 353, 365 (3d Cir.2012); The Fourth Circuit has described the Medicare statute as “among the most completely impenetrable texts within human experience.” Rehab. Ass'n v. Kozlowski, 42 F.3d 1444, 1450 (4th Cir.1994). Other courts of appeal, including the District of Columbia Circuit, have echoed this assessment. See Abraham Lincoln Mem. Hosp. v. Sebelius, 698 F.3d 536, 540–41 (7th east Hosp. Corp. v. Sebelius, 657 F.3d 1, 13 (D.C. Cir.2011); Alhambra Hosp. v. Thompson, 259 F.3d 1071, 1076 (9th Cir.2001). For a more literary-flavored spin, consider Judge Lamberth's recent characterization of the statute as akin to “a law written by James Joyce and edited by E.E. Cummings.” Catholic Health Initiatives–Iowa, Corp. v. Sebelius, 841 F.Supp.2d 270, 271 (D.D.C.2012), rev'd, 718 F.3d 914 (D.C. Cir.2013).
Allina Health System v. Kathleen Sebelius, 982 F.Supp.2d 1 (DCT DC 2013)
Friday, September 27, 2013
Lobbying In D.C. On Behalf Of Injured Workers
Regulations were proposed recently to operationalize the The SMART act. The public comment period is ongoing. Today's post comes from guest author Paul J. McAndrew, Jr., from Paul McAndrew Law Firm.
On April 17, my colleagues from WILG (Workers Injury Law & Advocacy Group) and I gathered in Washington D.C. to lobby Congressional representatives on behalf of injured workers. We discussed several bills that will affect the interests of workers in Iowa and across the United States. I had the pleasure of meeting with Senator Tom Harkin, Senator Chuck Grassley, Congressman Bruce Braley and Congressman Dave Loebsack in their offices where we discussed the following bills:
The MSP and Workers’ Compensation Settlement Agreement Act of 2012
The Akaka Amendment to S. 1789, The Post Service Reform Bill (an amendment to strip from S. 1789 those provisions that deform the Federal Employee Compensation Act).
As I explained at these meetings, the MSP and Worker’s Compensation Settlement Act of 2012 is necessary for three reasons:
(1) to bring some reasonable and understandable system to CMS’ current uncertain and regulation-less system of establishing Medicare Set-aside Plans for workers’ compensation settlements;
(2) to allow for an appeal of CMS’s MSA determination; and
(3) to bring some reasonable time limits to CMS’ process of setting the MSA required for workers’ compensation settlements.
The Akaka Amendment to strip the FECA deform provisions out of S.1789 is necessary because the FECA deform provisions wrongfully reduces monetary benefits and treats the injured worker like a fraud (mandating period independent medical examinations, vocational rehabilitation and field nurses to hound the injured worker). Workers' compensation reform is a constant threat to the rights of workers across the country. It is important that all of us who participate in the work' comp' system do our part to protect and preserve these legal rights.
Wednesday, June 20, 2018
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.
Tuesday, December 23, 2008
Seeking a Waiver of CMS/MSP Overpayment Request
A formal process exits to obtain a waiver of an Overpayment Recovery request from The Center for Medicare and Medicaid Services [CMS]. If SSA advises you or your client that it has made an overpayment, ie. Medicare Secondary Payer Act [MSP] recovery request, then a waiver request maybe made. This is not to be confused with a Request for Reconsideration which should be used where the amount is disputed.
If you or your client agrees that the number is correct and the beneficiary is unable to make repayment, then a Request for Waiver of Overpayment Recovery should be filed. The form is 8 pages in length and requires the submission of a reason for the request including no fault of the beneficiary or unfairness of the request.
A financial statement is required to be submitted to CMS which requests information concerning: current rent; mortgage payments; pay stubs; tax returns; utility, medical, charge cards and insurance bills; cancelled checks; spouse and dependent(s) financial information.
If you or your client agrees that the number is correct and the beneficiary is unable to make repayment, then a Request for Waiver of Overpayment Recovery should be filed. The form is 8 pages in length and requires the submission of a reason for the request including no fault of the beneficiary or unfairness of the request.
A financial statement is required to be submitted to CMS which requests information concerning: current rent; mortgage payments; pay stubs; tax returns; utility, medical, charge cards and insurance bills; cancelled checks; spouse and dependent(s) financial information.
Friday, April 24, 2015
CMS Posts Sample Notice To Beneficiaries Regarding Appeal Rights
CMS has posted the following notice regarding MSP Appeal Rights under the SMART Act. Under the process the the Social Security Beneficiary is only a party of notice and the the direct parties become the Insurance Carrier or Workers' Compensation Entity who initiates the appeal. The process has yet to unfold when an injured workers moves for standing to appear and participate in the process.
On February 27, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing certain provisions of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART ACT). This final rule establishes a formal appeals process for applicable plans (liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans) in situations where the Secretary seeks Medicare Secondary Payer (MSP) recovery directly from an applicable plan. The rule is effective April 28, 2015, and applies to demand letters issued on or after April 28, 2015.
Beneficiaries will be notified in writing if an item or service they received is the subject of an appeal by the insurer or workers’ compensation entity.
A new document titled Appeals Process for Insurers and Workers’ Compensation Entities and Required Notice to Medicare Beneficiaries has been loaded to the downloads section of the What’s New page on the Beneficiary Services section of CMS.gov. The following link can be used to access the main page http://go.cms.gov/beneficiary. Once on the main page click the “What’s New” link in the left side menu and scroll to the bottom of the page.
Monday, October 31, 2011
It is All The Same Apple
Another challenge to the Medicare Secondary Payer Act (MSP) has been introduced (H.R. 1063 in Congress. This is yet another attempt to bounce the dead cat on the floor.
The legislation is the third reiteration by insurance companies, and the cottage industry that has emerged to service conditional payment resolution. It is most likely doomed to failure reflecting the quick death of its predecessors and the worsening economic times.
Since the enactment of the MSP in 1980, there has been a slow, yet pervasive and effective effort by the US government to stop the shifting ofmedical costs from the workers’ compensation system onto the shoulders of the Medicare system.
Medicare has its own solvency problems, not withstanding cost-shifting by the workers’ compensation system. Medicare is trying to serve a growing constituency as costs soar and the base of available of income to tax dwindles. Medicare costs have become a major target for the “Super Committee” in Congress for cost reduction.
Statistics also reveal that the aging workforce is continuing to fall apart physically and file for Social Security Disability Insurance in lieu of workers' compensation at a greater rate than ever.. Even though more attention is now directed to major diseases such as cardio-vascular, cancer and diabetes, the aging bodies of the senior citizen population continue to need more medical care due to wear and tear alone. The barriers established through so-called reformed efforts have blocked the follow of new occupational disease cases into the workers' compensation system.
The aging workforce looks to Social Security Disability Benefits and Medicare as a more effective remedy, and one that takes precedence over applications for workers’ compensation. Fewer seniors, and those approaching that age, opt for workers’ compensation benefits. This pattern even puts more fiscal strain on the present Social Security and Medicare system.
Medicare is really not a free-ride for seniors and the government. While workers and their employers have made contributions for a lifetime, the system consume a large portion of the nation's economic wealth. Two major hospitalizations by a beneficiary exhaust all the individual and employer economic contributions completely from the reserves, and the government is stuck covering excess bills for the individual's lifetime.
As the US government continues to mandate stricter reporting and payment procedures the state workers’ compensation programs as the state programs to become further stressed by the Centers for Medicare and Medicar Services (CMS) reimbursement procedures. Both the federal and state systems have the same goal of providing assistance to disabled workers and their families.
As each continue to battle for a resolution of their own economic issues, they are merely shooting each other in the foot and weakening the entire purpose of each of their noble missions. Until a more unified system is established, it is incumbent upon both programs to direct their efforts to designing a more non-contentious system of resolution.
The mandatory arbitration of the cost medical reimbursement would be an interim step so that the workers’ compensation administrative process could go forward unimpeded. The problem of funding medical costs for the population should be considered one apple, and taking bites at it from every direction will merely result in a total deterioration of the entire process.
Thursday, August 1, 2013
CMS Comments: "No Comment" on The Forthcoming Smart Act Regulations
CMS is withholding comment about The Smart Act regulations for now. See the transcript below:
"CENTERS FOR MEDICARE & MEDICAID SERVICES
Moderator: John Albert
07-25-13/1:00 p.m. ET
Confirmation # 11907630
Page 14
That’s all I have on that right now. Some of the areas sort of more high
arching as oppose to just a single question. As we received a number of
questions about the SMART Act and how it affects this process and what
regulations are out there.
In terms of regulations, when CMS is doing an advance notice of proposed
rulemaking, an ANPRM or NNPRM or final rules or even a federal registered
notice, we’re not allowed to comment whether we are or are not doing that
notice or the content of that until there is at least something on the unified
regulatory agenda at which point we still can’t tell you specifics but we can
tell you that document is in progress. The site you need to go to for that
generally is – if I can find the right thing – is www.reginfo.gov. And what
that – you can also find it simply by Googling the Unified Regulatory Agenda
and then the term CMS. But what it lives on that, it won’t – and want – those
are ones that are in our process – officially in the process.
And right now, the requirement in the SMART Act that an ANPRM be done
with respect to civil money penalties under Section 111 is on that Regulatory
Agenda. I believe there are at least two other MSP related regulations either –
whether it’s under something in the final rule, a pre rule or proposed rule. But
you can check that out and that’s a site that you may want to monitor every so
often if you have a question about whether or not we’re doing a particular
regulation.
Similar to that, because I mentioned the SMART Act before, is a lot of the
questions were asking specific facts about our specific actions we planned to
take with respect to what’s in the SMART Act. As we make any changes or
do anything related to the SMART Act, we – anytime instructions are going to
change, we will give appropriate notice. At this point, there’s nothing that we
have changed in our instructions that affects you at this time. So, we won’t be
addressing any specific SMART Act questions.
Last but not least, as we have said in most of these calls, the extent we
received questions that are related to MSP recoveries in the mailbox, those are
outside the scope of this call. And we won’t be addressing those.
Read more about The Smart Act
"CENTERS FOR MEDICARE & MEDICAID SERVICES
Moderator: John Albert
07-25-13/1:00 p.m. ET
Confirmation # 11907630
Page 14
That’s all I have on that right now. Some of the areas sort of more high
arching as oppose to just a single question. As we received a number of
questions about the SMART Act and how it affects this process and what
regulations are out there.
In terms of regulations, when CMS is doing an advance notice of proposed
rulemaking, an ANPRM or NNPRM or final rules or even a federal registered
notice, we’re not allowed to comment whether we are or are not doing that
notice or the content of that until there is at least something on the unified
regulatory agenda at which point we still can’t tell you specifics but we can
tell you that document is in progress. The site you need to go to for that
generally is – if I can find the right thing – is www.reginfo.gov. And what
that – you can also find it simply by Googling the Unified Regulatory Agenda
and then the term CMS. But what it lives on that, it won’t – and want – those
are ones that are in our process – officially in the process.
And right now, the requirement in the SMART Act that an ANPRM be done
with respect to civil money penalties under Section 111 is on that Regulatory
Agenda. I believe there are at least two other MSP related regulations either –
whether it’s under something in the final rule, a pre rule or proposed rule. But
you can check that out and that’s a site that you may want to monitor every so
often if you have a question about whether or not we’re doing a particular
regulation.
Similar to that, because I mentioned the SMART Act before, is a lot of the
questions were asking specific facts about our specific actions we planned to
take with respect to what’s in the SMART Act. As we make any changes or
do anything related to the SMART Act, we – anytime instructions are going to
change, we will give appropriate notice. At this point, there’s nothing that we
have changed in our instructions that affects you at this time. So, we won’t be
addressing any specific SMART Act questions.
Last but not least, as we have said in most of these calls, the extent we
received questions that are related to MSP recoveries in the mailbox, those are
outside the scope of this call. And we won’t be addressing those.
Read more about The Smart Act
May 09, 2013
The SMART Act, which was signed into law by President Obama on January 10, 2013, amends and reforms the Medicare Secondary Payer Act to improve the reimbursement process. It is located in Title II of H.R. 1845 and ...
Feb 01, 2013
Enactment of The SMART Act, the reality of which is that the regulations will eat up the statute, and also their lunch. I plan to write more on The SMART Act in the coming weeks. Maybe that wasn't so smart after all for the ...
Jan 14, 2013
In additional to commenting on the new Strengthening Medicare And Repaying Taxpayers (SMART) Act, Judge Hickey will be discussing how the interaction of the workers' compensation claims process integrates with this ...
Friday, April 3, 2009
CMS/MSP Not Going To Require Pre 12/5/1980 Exposure Reporting, BUT....
CMS will not require reporting of claim data where the exposure occurred prior to 12/5/1980 (Effective date of the MSP Act), but if exposure continues after that date, that is another story.
"We were asked about the 12/5/80 date for liability and no fault and the date of incident. Yes we say that in general CMS is determined that it won’t pursue recovery if the date of CMS defined date of incident is prior to 12/5/1980. But then we give an example of a situation with a continuing DOI specifically with respect to exposure.
"If it’s easier for you to think of it that way, if you have a situation with exposure and that exposure continues on or after 12/5/80 it’s really like you’ve got a series of continuous multiple DOIs and we only require you to report the first DOI but yes we do have a recovery claim in that situation.
Transcript of Teleconference 3/24/1980, page 12
"We were asked about the 12/5/80 date for liability and no fault and the date of incident. Yes we say that in general CMS is determined that it won’t pursue recovery if the date of CMS defined date of incident is prior to 12/5/1980. But then we give an example of a situation with a continuing DOI specifically with respect to exposure.
"If it’s easier for you to think of it that way, if you have a situation with exposure and that exposure continues on or after 12/5/80 it’s really like you’ve got a series of continuous multiple DOIs and we only require you to report the first DOI but yes we do have a recovery claim in that situation.
Transcript of Teleconference 3/24/1980, page 12
Saturday, September 14, 2013
The Public and the Conflict over Future Medicare Spending
| Two recent government reports show substantial short-term improvements in the financial outlook for Medicare and in the federal budget deficit.1,2 However, these forecasts also suggest the need for further action brought about by a worsening of the financial situation after 2015 as the number of Medicare recipients increases from 52 million to 73 million in the decade following.1-3 This issue is likely to receive considerable attention in the upcoming debate about the federal budget deficit and the national debt. As we reported in the Journal in 2011, there has been little public support for major policy changes aimed at reducing Medicare spending to lower the federal deficit.4 This article goes further and seeks to document the underlying beliefs that may shape the public response to future efforts to substantially slow projected Medicare spending. Our thesis is that there exists today a wide gap in beliefs between experts on the financial state of Medicare and the public at large. Because of the potential electoral consequences, these differences in perception are likely to have ramifications for policymakers addressing this issue. We examine this thesis by analyzing data from six public opinion polls conducted in 2013 with 1013 to 2017 U.S. adults, plus historical data, in a project supported by the Robert Wood Johnson... Robert J. Blendon, Sc.D., and John M. Benson, M.A. N Engl J Med 2013; 369:1066-1073September 12, 2013DOI: 10.1056/NEJMsr1307622 |
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