September 5, 2006
Did you know...?
H.R. 5309: Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2006 was introduced By Rep. Clay Shaw [R-FL] to the 109th U.S. Congress on May 4, 2006. Major changes are being proposed to the Medicare Secondary Payer Act.
The Medicare Secondary Payer (MSP) Act was passed in 1981 to prevent shifting financial responsibility for medical treatment from a primary payer (insurer) to Medicare. Under the MSP Act, when an injured worker who is a Medicare recipient or about to become a recipient settles a workers' compensation claim, Medicare and insurers both have a share in who pays the long-term medical expenses. The Centers for Medicare and Medicaid Services (CMS) reviews those settlements to insure that an appropriate amount covering future medical expenses is "set-aside" to protect Medicare.
H.R. 5309 is a bill to amend section 1862 of the Social Security Act with respect to the application of Medicare secondary payer rules to workers’ compensation settlement agreements and Medicare set-asides under such agreements (MSP Act). H.R. 5309 establishes clear criteria for when a Medicare set-aside should be reviewed and certainty regarding the rules for calculating Medicare set-aside amounts. The amendment also speeds up the review process and provides protection to state-approved settlements. H.R. 5309 creates a system of certainty allowing the settlement process to move forward and eliminates millions of dollars in administrative costs that harm employers (especially small business), insurers, and CMS.
Medicare is a federally sponsored healthcare plan available to individuals who are over the age of 65 years and to individuals who have received Social Security Disability Insurance (SSDI) benefits for more than two years. A significant number of workers’ compensation claimants fall into these categories.
Since the mid-1980s, the Medicare as Secondary Payer Act has provided that Medicare is secondary to workers' compensation. If medical expenses could be covered under either workers’ compensation or Medicare, workers’ compensation, and not Medicare, should pay.
The proposed bill carves out exceptions from the MSP Act, whereby certain settlements need not consider Medicare’s interests in the settlement of workers’ compensation claims.
To learn more about H.R. 5309 point your browser to www.govtrack.us or click on the following link: http://www.govtrack.us/congress/billtext.xpd?bill=h109-5309.
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