Many Workers Compensation professionals believe they must secure approval of a Medicare Set-Aside (“MSA”) before they can close out medical benefits. In California terms, professionals think they cannot complete a full Compromise & Release (C&R) without going through a lengthy administrative process. This is not true.
1) MMSEA reporting makes approval unnecessary for Medicare beneficiaries. Carriers and self-insureds already report at the beginning of a claim that they are assuming Ongoing Responsibility for Medicals and will report again when the claim is closed. By the time an MSA is done, Medicare’s systems already block payments for treatment to those body parts.
2) Approval is not and never has been required. The law merely requires that Medicare’s interest be taken into account, which is what you are doing when you incorporate the MSA terms into the C&R.
3) Approval does not protect anyone from liability. When a non-Medicare-beneficiary Applicant self-administers and spends the money incorrectly, all parties could be subject to reimbursement liability.
4) The Approval process is unnecessarily torpedoing your settlements.
Do get an MSA Allocation report. Do create a Set-Aside in accordance with the report. Consider a structured settlement arrangement to make sure the Medicare Set-Aside is paid over the claimant’s anticipated lifetime. Consider custodial administration for claims where it is cost-effective. Seek CMS approval for settlements with a gross amount in excess of $250,000, but don’t let the process ham-string your settlement.
This is an abstract of an article originally published at LexisNexis® Legal Newsroom Workers Compensation Law. Find the full article at https://tinyurl.com/7f2c8n9.