06242017Headline:

Milestone Consulting, New York

HomeNew YorkMilestone Consulting

Email John Bair John Bair on LinkedIn John Bair on Twitter John Bair on Facebook
John Bair
John Bair
Contributor • (716) 883-1833

Update: The SMART Act Passes in the House

Comments Off

Note: The entry below was originally posted on November 1, 2012. On December 19, 2012, the SMART Act (H.R. 1063) passed in the U.S. House of Representatives as an amendment of H.R. 1845, the Medicare IVIG Access Act.

The post below provides a brief overview and discussion of the SMART Act, which has been estimated to reduce Medicare spending by $45 million. I strongly urge you to contact your United States Senators and ask them to pass these important reforms to the Medicare Secondary Payer program.

The SMART Act: Strengthening the Medicare Secondary Payer Program

The Medicare Secondary Payer ("MSP") program provides that in certain instances, Medicare is the primary payer for beneficiaries, but under other circumstances, the beneficiary's health insurance or coverage is the primary payer and Medicare is the secondary payer. Understanding Medicare guidelines can be trying, even for those accustomed to wading through government verbiage. For the typical American, it can feel almost impossible, which creates a huge problem for you as their attorney.

When it comes to Workers' Compensation and liability cases, the Centers for Medicare and Medicaid Services ("CMS") has not released regulations for the review of Medicare Set-asides ("MSAs"), although an informal agency memo has established a voluntary procedure for parties to seek review and approval of Workers' Compensation MSAs.

As those of you who have dealt with Medicare issues can attest, there have been many complaints about timeliness and efficiency on the part of CMS. In the words of House Energy and Commerce Committee Chairman Rep. Fred Upton,

"Although Congress has sought to improve Medicare Secondary Payer over the years, […], problems still persist. Today, many injury claims cannot be settled in a timely or conclusive manner because of the actions of CMS. […], party settlements are often delayed or settlement amounts placed in escrow until CMS can deliver a final amount–a process that can take years. This lack of a timely response has created a costly legal nightmare for large and small businesses, and created undue hardship on beneficiaries through no fault of their own."

On September 20, 2012, the House Energy and Commerce Committee passed H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act. The bill is intended to amend title XVIII of the Social Security Act by addressing many of CMS's problems in regards to the Medicare Secondary Payer program.

With revisions made by the Committee, the bill includes the following major improvements:

  • Response time: Within 120 days of a settlement, judgment, award, or other payment, the claimant or applicable plan may notify the U.S. Department of Health and Human Services that a payment is reasonably expected. The Secretary has 65 days from the receipt of a request to provide the Medicare reimbursement amount.
  • Web portal: The establishment of a web portal on the CMS website which gives users (e.g. attorneys, insurers, beneficiaries, third party administrators) the ability to access and update certain case-related information online. Website information must be updated no later than 15 days after the receipt of the claims.
  • Thresholds: The Secretary must establish a single minimum threshold by November 15th of each year exempting certain claims from MSP reporting requirements. This prevents the government from spending more than it collects on small claims.
  • Penalties: Penalties for non-payment will be discretionary, not mandatory, and will be relative to an offender's record of non-payment (if applicable).
  • Identifying information: Reporting requirements will be modified so that an applicable plan is permitted, but not required, to access or report beneficiary social security account or health identification claim numbers.
  • Statute of limitations: The government will not be permitted to bring action against a beneficiary who owes payment if the complaint is filed more than 3 years after the date of the receipt of notice of a settlement, judgment, award or other payment.

It is vital that as plaintiff advocates, we take a call to action and contact our legislators to ask for their support in simplifying the MSP program.