CMS and Dreaded Medicare Set-Aside Agreement Memo
What are the CMS and the dreaded medicare set-aside agreement memo effect on workers compensation? On July 1, 2009 the Center for Medicaid/Medicare Services (CMS) issued an innocuous-looking memo that will likely result in sanctions by the Federal Government and many lawsuits. In fact, a landmark Alabama lawsuit had been filed concerning an employee that was turned away by the CMS.
The carrier/TPA should have properly filed a Medicare Set-aside arrangement (MSA). The carrier did not file the MSA. A large number of future lawsuits can be expected, especially on closed Workers Comp files where no MSA’s were filed.
Check on my next post to see what all of this means to employers, TPA’s, and carriers. The letter issued on July 1, 2009 is as follows:
Workers’ Comp Data Match Cancellation Letter
[State name] has been participating in a voluntary data exchange program between [state’s Workers’ Comp division] and the Centers for Medicare & Medicaid Services (CMS). Through this program [State name] has been submitting certain Workers’ Compensation program information to CMS electronically. The information provided by the state has been assisting CMS in determining the nature of the Medicare program’s responsibility in the payment of Workers’ Compensation claims.
This voluntary reporting arrangement has now ended. On July 1, 2009, Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (the MMSEA) became effective for Workers’ Compensation insurance coverage. As of that date, the reporting of Workers’ Compensation information in support of Medicare Secondary Payer (MSP) determinations by CMS became mandatory. All existing voluntary reporting arrangements involving Workers’ Compensation programs are now null and void.
July 1, 2009, is the date Section 111 reporting became effective, but it is not the date that states will begin to report Workers’ Compensation information under the Section 111 requirements. In summary, states that will be reporting Workers’ Compensation data through the Section 111 process are required to register for Section 111 reporting by September 30, 2009. The testing of the electronic data exchange process will begin on January 1, 2010. The first “production” file exchanges will start on April 1, 2010.
The process for arranging Section 111 reporting, and all the reporting timeline benchmarks that have been established are described in full on the Section 111 Website, www.cms.hhs.gov/mandatoryinsrep . The current version of the “NGHP User Guide” and additional instructions needed to report Workers’ Compensation information are located on the Website’s “Liability Insurance, Self-Insurance, No-Fault Insurance and Workers Compensation (NGHP)” page.
Thank you for your participation in the voluntary workers’ compensation data information-sharing program with CMS. If you have questions about your state’s responsibilities under the mandatory Section 111 reporting requirements, please contact William Decker of my staff at (410) 786-0125.
Division of Medicare Benefit Coordination
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