Welcome to the TIPS Workers’ Compensation and Employers’ Liability Committee.
David Eppstein, ABA Legislative Counsel, has asked that TIPS Workers Compensation and Employers Liability Committee members contact their Representative or Senator and ask for co-sponsorship of the Medicare Secondary Payor Act bill.
When Medicare began in 1966, it was the primary payer for all claims except for those covered by Workers' Compensation, Federal Black Lung benefits, and Veteran’s Administration (VA) benefits. In 1980, Congress passed legislation that made Medicare the secondary payer to certain primary plans in an effort to shift costs from Medicare to the appropriate private sources of payment. Workers’ Compensation pays Primary for health care items or services related to job-related illness or injury claims. Medicare generally will not pay for an injury or illness/disease covered by workers’ compensation. Medicare may pay a claim that relates to a medical service or product covered by Medicare if the claim is not covered by workers’ compensation. Prior to settling a workers’ compensation case, parties to the settlement should consider Medicare’s interest related to future medical services and whether the settlement is to include a Workers’ Compensation Medicare Set-aside Arrangement (WCMSA).
Identical House and Senate bills will be introduced within the next few weeks. Introducing sponsors in the House are: Rep Reichert (R - WA) and Rep Thompson (D - CA). Introducing sponsors in the Senate are Sen Nelson (D - FL) and Sen Portman (R - OH).
Delays in review of the Set-aside amount have resulted from the contractor and CMS engaging in an unpredictable, inefficient and slow process that is costly to injured workers, employers, insurers and states that administer the workers’ compensation laws.
The proposal would:
- Establish clear criteria for when a set-aside may be reviewed by Medicare;
- Create certainty for calculating the amounts to be included in set-asides;
- Provide a reasonable time frame in which CMS is to review set-aside submissions;
- Provide an appeals process for parties to CMS determinations;
- Provide an optional direct payment of set-aside amounts to Medicare;
- Assure that settlements that meet the terms of federal statute at the time of settlement are not disapproved based on later changes in law, regulations or administrative interpretations by CMS;
The proposal will benefit injured workers, employers, insurers and CMS. It creates a system of certainty and allows the settlement process to move forward while eliminating millions of dollars in administrative costs that harm workers, employers (especially small business), insurers, and CMS.
Co-sponsors in the House Committee on Ways and Means and Senate Committee on Finance are needed. It is requested that you contact your Senator or Representative in writing or by phone to let him/her know how important this bill is to our practice and to seek their support and/or co-sponsorship of the bill.
Registration for the ABA Annual Meeting (July 30-August 3, 2015) is now open. TIPS has been assigned the Swissotel in Chicago, IL. Standard registration ($50.00) provides access to entity committee meetings, ABA governance meetings, the General Assembly, presentation of the ABA Medal on Saturday, and access to the ABA EXPO.
The Employment Law Committee is taking the lead in arranging a group event for Chicago and it may be a river cruise. More details will follow.
The due dates for submission of articles for our final Committee newsletter of this ABA year is June 17, 2015. Please submit your articles for the newsletter directly to Lindsey Mills (email@example.com).
The questions to be answered in our 50 State Workers’ Compensation Compendium have been finalized. You will be contacted shortly by Debra Doby for your help in answering 5-7 questions. You may be asked to answer more questions depending on the number of members in your state.
Stacy A. Tees
ABA TIPS Workers’ Compensation and Employers’ Liability Committee