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ARC:HOW EMPLOYERS CAN AVOID POTENTIAL PITFALLS DEALING WITH MEDICARE LIENS AND SET-ASIDES

Bill to ease workers comp Medicare set-aside process introduced

Medicare Secondary Payer

A bill that would ease the Medicare Secondary Payer reimbursement process for workers compensation settlements has been introduced in Congress.

U.S. Reps. Dave Reichert, R-Wash., and Mike Thompson, D-Calif., introduced H.R. 1982, the Medicare Secondary Payer and Workers' Compensation Settlement Agreement Act, on Wednesday, according to a statement from Rep. Reichert's office. The legislation would streamline the process for approving Medicare set-asides, which pay for an injured worker's future medical care when that person is eligible or expected to be eligible for Medicare.

The full text of the bill was not immediately available. An earlier version of the same bill was submitted last year and stalled in the House subcommittee on health.

Medicare Secondary Payer regulations require insurers and self-insured employers to repay the Centers for Medicare and Medicaid Services for a Medicare beneficiary's medical treatment related to workers comp or liability cases. Experts have said it can take months for CMS to approve Medicare set-asides, slowing the settlement of workers comp claims.

However, sources note that the approval process has been quicker since CMS began using a new contractor for approvals last year.

The Washington-based American Insurance Association lauded the bill's introduction.

“The CMS workers compensation Medicare set-aside review process is broken, and this legislation seeks to fix the costly delays and problems within the system,” Melissa Shelk, AIA vice president for federal affairs, said Wednesday in a statement. “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.”

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