Medicare’s Epic Game of “Kick the Can” Continues…

December 20, 2021

Yet again, Medicare pushed back the unveiling of a notice of proposed rulemaking on regulations governing post-settlement medical care of Medicare beneficiaries. ECS briefed this issue in both July and December 2020 and at that time Medicare planned to release the proposed regulation in March 2021. March came and went without fanfare, and then in June Medicare and the Office of Management and Budget said they would introduce the notice in October. October came and went also without fanfare. Medicare recently updated the notice and they are aiming for February 2022 now. It is widely thought this notice will include guidance specific to Liability Medicare Set-Asides.

Please recall the proposed rule would clarify existing MSP obligations associated with future medical items services on any bodily injury settlement. The notice previously indicated that “this rule would clarify that an individual or Medicare beneficiary must satisfy Medicare’s interest with respect to future medical items and services related to such settlements, judgments, awards, or other payments.” The regulatory notice had consistently indicated that Medicare’s interest in post-settlement payments must be “satisfied.” 

Interestingly, the updated language removes the concept of “satisfaction” of Medicare’s interest. We’ve been following this regulatory development since December 2018, when this regulatory notice was first introduced but the concept goes all the way back to the 2012 Advanced Notice of Proposed Rulemaking (ANPRM) on MSP and Future Medicals.  This continues to bear watching and ECS will provide further updates on any developments.

Other Medicare Secondary Payer News

Medicare also recently released their reporting and recovery thresholds for Non-Group Health Plans. The amounts remain unchanged from the last several years at $750. This means that single settlements at or below $750 are essentially

ExamWorks Compliance Solutions continuously monitors regulatory and legislative developments in the Medicare Secondary Payer space.  For further information or if you have any questions, contact Senior MSP Compliance Counsel and Policy Strategist Annie M. Davidson at 651-262-9618 or annie.davidson@examworkscompliance.com.

Annie M. Davidson

Annie M. Davidson

Annie M. Davidson is the Senior MSP Compliance Counsel and Policy Strategist for ECS. In her role, Annie provides legal analysis to ensure the integrity and quality of ECS’ Medicare Secondary Payer (MSP) compliance services and related products. Prior to joining ECS, Annie practiced as an insurance defense attorney in her native Minnesota where she litigated workers’ compensation and liability insurance cases, particularly those involving MSP issues. She is admitted to practice law in the State of Minnesota and the United States District Court for Minnesota, and is a graduate of William Mitchell College of Law. Annie can be reached at annie.davidson@examworkscompliance.com or at 651-262-9618.