News Concerning Developments with regard to
Medicare Set Aside proposals
January 2, 2008
During the end of year deliberations by Congress a provision was included in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (S. 2499) imposing new requirements for MSP submissions by or on behalf of Liability Insurance, self-insurers, no fault insurance, and workers' compensation laws and plans.
Effective 18 months after enactment (June 2009), the statutory language requires that the applicable plan determine whether a claimant, including an individual whose claim is unresolved, is entitled to benefits under Medicare on any basis, and submit the identity of the claimant to the Secretary of HHS in order to enable the Secretary to make an appropriate determination concerning coordination of benefits.
The information about each claimant is to be submitted within a time specified by the Secretary after the claimant is resolved through a settlement, judgment, award or other payment, regardless of whether or not there is a determination or admission of liability.
An applicable plan failing to comply with the new requirements is subject to a civil money penalty of $1,000 for each day of non-compliance with respect to each claimant.
These new reporting requirements were developed by and supported by Senator Baucus and Senator Grassley as part of the legislation to increase physician payments and the physician quality reporting system. The Congressional Budget Office projected that Section 111 would generate $1.1 billion in offsets for additional federal outlays under S 2499 over the 10 year budget period ending 2017.
Douglas J. Holmes, President
UWC- Strategic Services on Unemployment & Workers' Compensation
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