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WASHINGTON—Members of the House of Representatives on Friday introduced bipartisan, federal legislation that seeks to eliminate delays and confusion caused by a federal agency's review of workers compensation Medicare set-asides.
The reviews are conducted by the Centers for Medicare and Medicaid Services, but employers have long complained that confusion over meeting CMS requirements prevents the timely resolution of claims. A Medicare set-aside is an allocation for future medical expenses required for claimants reaching retirement age so that Medicare is not on the hook for those costs.
The legislation was hailed by self-insured employers, insurers and worker representatives.
Passage of the Medicare Secondary Payer and Workers' Compensation Settlement Agreement Act of 2012, introduced by Rep. Dave Reichert, R-Wash., and Mike Thompson, D-Calif., would compel CMS to make timely decisions and address costly problems that impact workers, insurers and employers, supporters said.
The act “will provide clear and consistent standards for the CMS administrative process,” said Douglas Holmes, president of the Washington-based UWC-Strategic Services on Unemployment and Workers' Compensation and coordinator of the Coalition for Medicare Secondary Payer Reform.
“CMS takes too long to review proposed set-asides, fails to provide appropriate and consistent standards for determining amounts to be set aside, and provides no avenue to appeal CMS determinations,” Mr. Holmes said in a statement. “The process results in injured workers not receiving funds, additional costs for states and workers' compensation payers, and additional liability for employers, insurance carriers, and attorneys. A legislative solution to this problem is needed.”
The American Insurance Assn. called the set-aside issue a “pervasive workers compensation claims problem” and praised the legislation's introduction, which does not yet have a bill number.
“This legislation will provide clear and consistent standards for the CMS administrative process,” Melissa Shelk, AIA vp for federal affairs, said in a statement. “The current CMS set-aside review process is both cumbersome and confusing. Reps. Reichert and Thompson understand that a legislative solution is needed to address stakeholders' concerns and to reform a broken system.”
The introduction of the new legislation, however, is not the first time stakeholders have proposed legislation attempting to reform CMS' procedures.
WASHINGTON—The Centers for Medicare & Medicaid Services says it intends to survey employers and other early retiree health care plan sponsors on how they used money provided under a federal program.