New House Bill Attempts to Change Medicare Set Asides


On July 26, 2018, HR 6619, known as the “Medicare Secondary Payer and Workers’ Compensation Settlement Act of 2018” was introduced in the House of Representatives. The purpose of the bill is to amend Title XVII of the Social Security Act to provide for Medicare Secondary Payer rules to certain workers’ compensation settlements and qualified MSA provisions.

The bill contains provisions that could materially change the current MSA landscape.
In short, it allows for:
  1. The claimant or the payer may elect to calculate the MSA amount of the agreement by applying a percentage reduction to the MSA amount for the total settlement amount that could have been payable under the applicable WC law. Both parties must agree in writing.

  2. The MSA submission process remains optional however the reviewer has 60 days to make a determination in writing and, if the submitted amount is not approved, the reasons for disapproval must be stated.

  3. If dissatisfied with the determination, either party may request, within 60 days, shall be entitled to a) reconsideration , b) a hearing before an administrative law judge, and judicial review after the administrative law judge hearing.

  4. Either party may elect to transfer the MSA money to CMS but it’s not required. Likewise, the parties are free to allow self-administration or professional administration.

  5. The approval of a state WC settlement that includes a MSA shall be “final and conclusive.”

Similar to S. 3079 Bill, introduced on June 18, 2018, seeks to promote the same rules, but also asks that CMS establish the adequacy and application of state provisions and state fee schedules for Medicare Set-Asides consistent with the requirements of state rules and guidelines.

The H.R. 6619 bill was transferred to the Committee on Ways and Means as well as the Committee on Energy and Commerce. The success of the bill is debatable but Congress is showing an increasing interest in how MSAs operate in the non-group health environment.

Care Bridge International’s integrated Medicare Secondary Payer program is uniquely positioned to accommodate the passage of these bills, as our technology helps you generate a Medicare Set Aside in minutes instead of weeks. Fidelity Fiduciary’s Post Settlement Account Administration of Non-Submit MSAs ensures the protection of MSA funds, when funds are not paid directly to CMS. This winning strategy is available now. We will keep you informed as both bills move through the legislative process.

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 deborah@carebridgeinc.com

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