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New Medicare Secondary Payer Amendment Proposed.

Byline: Arthur D. Postal, PropertyCasualty360.com

Congress is again being asked to amend the Medicare Secondary Payment Act, just six months after enacting reform legislation dealing with the issue, which took five years to pass congressional muster.

The Medicare Secondary Payer and Workers' Compensation Settlement Agreements Act of 2013 was introduced Wednesday in the House, sponsored by Rep. Dave Reichert, R-Wash., and Mike Thompson, D-Calif.

The new legislation seeks to reform the processes and procedures used by Centers for Medicare and Medicaid Services (CMS) in its review of workers' compensation settlement agreements.

Strong supporters include members of the American Insurance Association and the Coalition for Medicare Secondary Payer Reform.

The bill seeks to resolve the serious delays and confusion in the review of workers' compensation Medicare set- asides by CMS, says to Melissa Shelk, AIA vice president for federal affairs, and Douglas Holmes, president of Strategic Services on Unemployment and Workers' Compensation (UWC) and coordinator of the Coalition for Medicare Secondary Payer Reform.

"The CMS workers' compensation Medicare Set-Aside (WCMSA) review process is broken, and this legislation seeks to fix the costly delays and problems within the system," Shelk said. "We believe that the CMS review process needs clear and consistent standards, timely resolution of coverage decisions and the ability to enable appeals when necessary."

Holmes said reform is being sought because the current procedure for review of workers' compensation settlements provides no effective recourse."

He said, "There is no avenue to compel a timely decision or appeal a bad one. The legislation introduced by Representatives Reichert and Thompson corrects this situation and many other costly problems and delays, for the benefit of all parties involved."

Catherine Stanton, president of the Workers Injury Law and Advocacy Group (WILG), the national association of attorneys representing injured workers in workers' compensation cases, said reform is necessary because, "Too often, injured workers bear the brunt of the delays caused by the current system and reforms are needed now."

She said the bill "is about process improvement and fair treatment of all parties."

Stanton explained that, "In case after case we hear of delays in approval, uncertainty of the amount to be reimbursed by injured workers, and changes in amounts to be set-aside after settlements have already been approved."

In December, Congress passed legislation sought by the insurance industry and other stakeholders since late 2008 that streamlines enforcement of the Medicare Secondary Payment program.

The legislation is H.R. 1063, the SMART Act, or The Strengthening Medicare and Repaying Taxpayers Act.

The bill is example of how difficult it is to get special interest legislation through Congress is so difficult.

The SMART Act was first introduced in Congress in the fall of 2010, but momentum for passage was not generated until last September, when the House Energy and Committee staff coalesced on a rewritten bill crafted with bipartisan support and passed it in late September.

The reason that bill finally got through Congress is that supporters included plaintiffs and defense attorneys, brokers, insureds, insurers, insurance and trade associations, self-insureds and third-party administrators.
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Publication:Property and Casualty 360
Date:May 16, 2013
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