President
Obama signed into law changes to the Medicare Secondary Payer Act. The laws
change the reporting requirements for settlements and judgments with Medicare
and Medicaid beneficiaries, and the process for requesting demand letters from
the Center for Medicare and Medicaid Services ("CMS"). The timeline
for the changes includes:
Section
201: Effective nine months after the after the deadline by which CMS must
promulgate final regulations to carry out the legislation. This section applies
to both workers' compensation and liability claims. It set out a process by
which parties may request a demand letter from Medicare that is good for a
period of time before disposition of the case. CMS must be provided notice
within 120 days of and expected or reasonably expected settlement date, and
that the expected date. CMS has 65 days to produce a demand letter, but can
extend this timeframe by an additional 30 days. Parties may then retrieve the
demand information from the CMS website and rely on it so long as the
settlement occurs within 120 days of notice and 3 days from the last download
of the website. There is also a dispute process in Section 201. If a dispute is
raised the Secretary’s determination is final and not subject to appeal. The
procedure outlined in Section 201 is an alternative, and does not replace that
procedure currently in place. Lastly, Section 201 grants a new right to the
insurance carrier to appeal without the consent of the Medicare beneficiary, only
if notice is given to the Medicare beneficiary.
Section
202: Effective 1/1/2014. This section applies to liability claims excluding
ingestion, implantation, and exposure cases. It provides that there is no
obligation to repay Medicare under 42 U.S.C. § 1395y(b)(2)(B)(ii) or to report
under 42 U.S.C. § 1395y(b)(8) if a claim falls below the annual threshold as
set by the Secretary of Health and Human Services. The threshold for a given
year shall be published by the Secretary by November 15 of the previous year.
CMS must report to Congress on thresholds for workers’ compensation and no
fault cases.
Section
203: This section amends the Mandatory Insurance Reporting law. It changes the
civil penalty amount of $1,000 for each day of non-compliance concerning a
given claimant by adding the language “up to.”
This additional language gives Medicare discretion. This section also
requires Medicare within 60 days of enactment, to solicit proposals for safe
harbor situations, and propose final safe harbor regulations for good faith
efforts when a Medicare beneficiary cannot be identified.
Section
204: Effective 18 months after enactment, but the Secretary may apply to
Congress for a 12-month extension. This section amends the Mandatory Insurance
Reporting law. It allows insurance companies responsible for electronic
reporting to report without requiring the use of a Medicare beneficiary’s
social security number or Health Care Identification Claim Number. This applies
to all claims subject to Mandatory Insurance Reporting. The change provides an
alternative so that insurance carriers do not have the burden of protecting
certain sensitive information.
Section
205: Effective six months after enactment. This section applies to all workers’
compensation, liability, and no fault claims. This section amends actions
brought by the U.S. pursuant to 42 U.S.C. §1395y(b)(2)(B)(iii) and limits
actions to enforce reimbursement claims and penalties to three years from the
Mandatory Insurance Report of a settlement, judgment, award or other payment.
This section creates a clear standard, but to trigger protection, the claim
must be electronically reported under 42 U.S.C. §1395y(b)(8).