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Insurance insiders still hopeful that Congress will pass Medicare bills

Insurance insiders still hopeful that Congress will pass Medicare bills

With Congress set to adjourn this month, insurance insiders said they still hoped lawmakers would push through two bills intended to alleviate common Medicare Secondary Payer issues.

Observers said H.R. 1063 and H.R. 5284 would help simplify the process of reimbursing the Centers for Medicare and Medicaid Services, which holds insurers and self-insureds responsible to pay for a Medicare beneficiary's medical treatment related to workers compensation or liability cases.

As fiscal cliff issues dominated much of the legislative discussion, observers remained hopeful that the legislation would be included in an end-of-year bill package.

“Congress hasn't moved very many bills at all (this year), so everybody wants their bills moved, if they can,” said Keith Bateman, vice president of workers compensation for the Des Plaines, Ill.-based Property Casualty Insurers Association of America.

H.R. 1063, the Strengthening Medicare and Repaying Taxpayers Act, aims to ease the process of finding out how much an insurer or self-insured must pay to CMS for Medicare-funded treatment of work- or liability-related injuries.

Currently, CMS does not tell settlement parties how much is owed for Medicare reimbursement until after a settlement has been reached. Observers said that procedure prevents claims from being closed as they await a “final demand” letter from CMS.

“Everybody wants to know what the numbers are so that we can agree on a settlement amount,” said Roy Franco, co-chair of the Washington-based Medicare Advocacy Recovery Coalition. “When you don't know what the numbers are, it tends to make everybody pause.


The SMART Act would require CMS to issue its final demand prior to a workers comp or liability settlement agreement. It also would establish a minimum threshold for settlements in which CMS can seek Medicare reimbursement and set a three-year statute of limitations for CMS to seek reimbursement from a settled claim.

Last week, the U.S. House passed provisions of the SMART Act as part of H.R. 1845, the Medicare IVIG Access Act. The parent bill would study access to intravenous immunoglobulin for Medicare beneficiaries. The legislation was sent to the Senate for further consideration. Late Friday the Senate had not yet acted.

H.R. 5284 would set a minimum threshold of $25,000 for workers comp settlements that require Medicare set-aside accounts, which pay projected future medical costs for Medicare-eligible workers. The bill also would allow payers to skip set-aside agreements for claimants who are likely to be ineligible for Medicare coverage within 30 months of their settlement.

Both bills are supported by industry groups such as PCI and the American Insurance Association. Melissa Shelk, vice president of federal affairs for the AIA in Washington, noted that Medicare secondary payer legislation has turned claimant attorneys, employers and insurers into unlikely allies, since the groups believe that the bills will ease the settlement of workers comp and liability cases.

“That shows you what kind of a problem there is out there, that we all came together to address it,” Ms. Shelk said.


The bills could help make the Medicare secondary payer process less challenging over time, said Martin Cassavoy, vice president of strategic services at North Reading, Mass.-based Crowe Paradis Services Corp., a Medicare secondary payer compliance company.

“Everybody who deals with this process on a daily basis would probably, at some point ... see more predictability,” Mr. Cassavoy said.

Mr. Franco said the SMART Act's savings could help the bill get pulled into an end-of-year legislative package, since lawmakers would seek to pass bills that won't increase the federal deficit. The Congressional Budget Office estimated in November that the SMART Act would reduce Medicare spending by $45 million from 2013 to 2022.

If the bills are not passed during 2012, observers said they expect both to be reintroduced during the next term. “A lot of the people that have sponsored the legislation have been reelected, so there's still a lot of interest there and it's not going to go away,” Mr. Franco said.