It is that time of year when we alert you to a Workers’ Compensation Medicare Set-Aside bill in Congress. Rep. Mike Thompson (D-CA) introduced H.R. 4161 on August 2nd. The bill’s co-sponsor is Rep. George Holding (R-NC). Recall Rep. Thompson co-sponsored this same piece of legislation last year, only renaming the bill as the “Coordination of Medicare Payments and Workers’ Compensation Act” or the “COMP Act” instead of the “Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act.”
Here is a summary of the COMP Act. It:
- Creates a formal appeals process for Medicare Set-Asides where the parties are dissatisfied with Medicare’s future medical recommendation.
- Establishes a process whereby the beneficiary could elect to pay Medicare directly rather than administer their Medicare Set-Aside. By paying Medicare directly, the beneficiary could simply utilize his/her Medicare coverage post-settlement.
- Requires CMS to acknowledge state workers’ compensation law in its review of any MSA proposal.
- Codifies certain details about MSAs that are currently driven by policy, such as use of state workers’ compensation fee schedules where available.
- Modernizes language to change the term “workman’s compensation” to “workers’ compensation” throughout the MSP statute.
- Creates a process for “compromise settlements” whereby parties could adjust the amount of an MSA downward in direct proportion to the denied components of the underlying workers’ compensation claim.
- Confirms that CMS review of an MSA proposal is never required.
Apart from the title change, there are no changes to this bill. Each Congressional session a Medicare Set Aside reform bill is introduced but Congress has failed to act on any of them. With a regulatory announcement anticipated before year end, the bill could attract Congress’ attention depending upon the exact nature and content of any proposed regulatory changes.
As always, we closely monitor legislation and will provide updates as they materialize. Should you have any questions in the meantime, please contact Annie M. Davidson at 651-262-9618 or firstname.lastname@example.org.
About Annie M. Davidson
Annie M. Davidson is MSP Compliance Counsel for ExamWorks Clinical Solutions. In her role, Annie provides legal analysis to ensure the integrity and quality of ExamWorks' Medicare Secondary Payer (MSP) compliance services and related products. Prior to joining ExamWorks, Annie practiced as an insurance defense attorney in her native Minnesota where she litigated workers’ compensation and liability insurance cases, particularly those involving MSP issues. She is admitted to practice law in the State of Minnesota and the United States District Court for Minnesota, and is a graduate of William Mitchell College of Law. Annie can be reached at email@example.com or at 651-262-9618.