Although there is no formal process for reviewing LMSAs, the statutory duty is the same as in workers’ compensation cases
When future medicals are a consideration in arriving at the settlement, appropriate arrangements should be made to exhaust the funds before Medicare pays
The MSP Act, which requires the protection of Medicare, is the exact same in liability cases as workers’ compensation cases.
CMS stated they have an 18-month time-frame (from April 2018) before it rolls out a LMSA review program
The program would be voluntary
CMS has indicated that their enforcement mechanism is the denial of services
CMS felt strongly that the injured party must receive something (free and clear) through settlement.
CMS would not review an LMSA until settlement has been reached.
CMS feels a LMSA is exclusively the responsibility of the plaintiff
Regarding LMSAs, CMS made it clear that the defendant(s), and their insurers, are not a target
Medicare pricing of services was discussed.
CMS does not feel it can mandate professional administration.
CMS would publish a LMSA Reference Guide
Eligibility remains the same as the current WCMSA system- Medicare beneficiaries or injured parties who have a reasonable expectation of Medicare eligibility within 30 months. Per statute, Medicare’s interest must be considered in every claim.
A workload threshold of $250,000 is anticipated – “NO SAFE HARBOR”. The level mirrors the $25,000 workload threshold for WCMSAs.
For settlements between $250,000 and $750,000 threshold, CMS approval is available and encouraged by CMS. CMS would apply “a formula” to determine the LMSA amount. Starting with the total settlement amount, CMS would subtract certain expenses and apply the discount factor to total settlement.
Above $750,000 level is full commutation. A traditional MSA would be prepared and, if submitted to CMS< evaluated by CMS for adequacy.
Segregate the future medicals from other claimed damages, such as economic, pain and suffering, loss of consortium, etc.
Always secure a professional cost projection or Medicare Set Aside for complex, catastrophic injuries such as spinal cord injury, traumatic brain injury, limb amputations, complex 3 or 4th degree burn injuries, multiple trauma or chronic and progressive environmental exposure claims that includes treatment, pharmacy and durable medical equipment.
Use professional administration of the LMSA funds. These funds should be protected against levy and cost containment is advised.
For standard or nuisance value claims, leverage data driven technology-based medical forecasts that can be calculated in minutes using machine learning algorithms of injury claims, such as the SaaS technology available through Care Bridge International. Paired with post settlement account administration or support, a claim may be settled the same day.
If a case is tried, submit special interrogatories to the jury to establish the value of the future medicals.
If a general verdict is reached, request a decision that parcels out the future medical costs from the court.
Bennett L. Pugh, JD Chief Executive Officer Fidelity Fiduciary Company, LLC P.O. Box 43613 Birmingham, AL 35243-0613 Mobile: 205-901-1116 Ben@FFCadmin.com
Deborah Watkins Chief Executive Officer Care Bridge International, Inc. MSP Compliance Bridge, LLC 9040 Town Center Parkway Lakewood Ranch, FL 34202 Toll-Free: 888-434-9326 email@example.com