For many years, prominent stakeholders in the U.S. workers’ compensation community have urged reform to the review process of workers’ compensation Medicare set asides by the Centers for Medicare and Medicaid Services (CMS). Interest groups calling for reform have cited long review times and arbitrary procedures as significant problems in the Medicare set aside review process.

In an attempt to streamline the CMS review process, Representative John Tanner (Tennessee) re-introduced legislation (H.R. 2641) on May 21, 2009 to amend section 1862 of the Social Security Act. H.R. 2641 was co-sponsored by Rep. Robert Brady (Pennsylvania), Rep. Travis Childers (Mississippi), and Rep. Jim Matheson (Utah). The bill was referred to the Committee on Ways and Means and the Committee on Energy and Commerce.

One intent of the legislation is to establish clear standards for the exemption of workers’ compensation settlements that are of sufficiently low value and others that pose no significant potential for future medical costs to the Medicare program. The bill also establishes a safe harbor (i.e. set aside is deemed qualified) for some relatively low value settlements that have threshold amounts set aside for future medical costs.

Another outcome of the reform proposal is to set standards for the review process by CMS and its contractors and establish standards for the payment amounts to be reserved in set asides.

CLICK HERE to read the full text of bill H.R. 2641.
 

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