H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act, had gained a significant amount of bipartisan support in both the House and Senate; however, with the election pending, the outlook seemed bleak that it would be passed by the 112th Congress. Well, on September 13, 2012, the Energy and Commerce Subcommittee on Health met in an open markup session and made certain adjustments to the bill to implement more automated functions to the conditional payment recovery process. The committee met again on September 20, 2012, and again made minor adjustments to the bill, then favorably forwarded it to the full committee and sent it back to the CBO for scoring. There was no further indication of progress until on December 19, 2012, a lesser version of the SMART Act emerged as Title II of the Medicare IVIG Access Act [H.R. 1845]. H.R. 1845 proposed a $45 million dollar demonstration project to study providing Medicare coverage for in-home administration of intravenous immune globulin (IVIG) to patients suffering from primary immune deficiency disease. Despite the sympathetic appeal of helping the bubble boy, H.R. 1845 needed to be off-set by a bill such as the SMART Act, which proposed to coincidentally save Medicare $45 million dollars over ten years, and the match was made. The new combined bill was nearly unanimously passed by the House on December 20, 2012, and passed by the Senate on December 21, 2012. On January 10, 2013, President Barack Obama signed the legislation, making it
Video: Navigating the Medicare Secondary Payer Act
Medicare Secondary Payer Act Compliance
There are no simple answers when complying with the Medicare Secondary Payer Act in your workers’ compensation, no-fault/automobile or liability claim. In any of these cases where future medical care and treatment is closed out, it is important to consider and protect Medicare’s future interests—do not forget about conditional payments too! Failure to address these issues at the time of settlement may result in Medicare considering the entire settlement null and void, regardless of what “Medicare savings” language you use.
Statement to the Record on the Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act
HR 5284 creates a system of certainty and allows the workers’ compensation settlement process to move forward while eliminating millions of dollars in administrative costs. It will help create clear and consistent standards, currently lacking in the process, to address workers’ compensation issues. Most importantly, it will benefit all parties involved – injured workers, employers, insurers and CMS.
SMART Act Amends Medicare Secondary Payer Statute, Creates Three
The SMART Act requires the Secretary of Health and Human Services (“Secretary”) to establish a process by which a claimant (or his or her authorized representative) can dispute discrepancies with the statement of reimbursement amount. A claimant or authorized representative must submit documentation of the potential discrepancy and a proposed resolution to the Secretary. The Act states that the Secretary must determine whether there is a reasonable basis for including or removing a claim and provide a response within eleven (11) business days. Lack of a response is a deemed acceptance of the claimant’s proposal. If the Secretary determines that there is not a reasonable basis to include or remove claims, the proposal will be rejected. If the Secretary concludes that there is a discrepancy, but rejects the proposed resolution, documentation showing good cause for why the Secretary has rejected the proposal and establishing an alternate discrepancy resolution must be provided to the claimant. This process does not create an appeals process, however, and the SMART Act expressly forecloses the possibility of administrative or judicial review of the Secretary’s determinations. Final regulations must be promulgated by October 10, 2013, nine (9) months after the date of enactment, the effective date of this provision.
MICHIGAN DISTRICT COURT HOLDS THAT MEDICAL PROVIDERS CAN BRING MSP PRIVATE ENFORCEMENT ACTIONS WHEN INSURER DENIES COVERAGE
, 656 F.3d 277 (6th Cir. 2011), which held that a health care service provider may bring a private action to enforce the MSP Act before a court or other adjudicative body has determined whether or not the insurer/primary payer is liable for the medical charges incurred. This means that where an insurance carrier refuses to cover a Medicare beneficiary’s bills for medical services rendered by a medical provider, the medical provider can sue the insurance carrier seeking double damages even when no determination has been made that the insurance carrier was liable for the beneficiary’s medical treatment.
Summary of SMART Act which amended Medicare Secondary Payer Act
The SMART Act requires parties to notify CMS of when they reasonably anticipate settling a claim (any time beginning 120 days before the settlement date). CMS then has 65 days to ensure the portal is up to date with all of the appropriate claims data. CMS can have an additional 30 days on top of the 65 days to update the portal if necessary. At the expiration of the 65 and potentially the 30 day periods, the parties may download a final conditional payment amount from the website. The final conditional payment amount is reliable as long as the claim settles within 3 days of the download.
Petition of the day : SCOTUSblog
Issue: (1) Whether post office sidewalks that are open to the public are public fora, so that a prohibition of First Amendment activities must be narrowly tailored to further a significant governmental interest; and (2) even if post office sidewalks are not public fora, whether the 30 C.F.R. § 232.1(h)(4), the regulation banning signature gathering on petitions, is reasonable when it simultaneously permits the collection of signatures in voter registration drives on the same sidewalks, and when the justification for the latter provision (that it is the solicitation of a signature, rather than its collection, that may be disruptive) directly contradicts the justification for the former provision (that it is the collection of a signature, rather than its solicitation, that may be disruptive).