If Congress passes one or both of two bills presently sitting in congressional committees, then parties to a workers’ compensation (WC) case may finally have a solution to a problem that has plagued that system since its inception. Each of the two proposed bills originates in the separate chambers, and both appear to share a [...]
Despite notable guidance available in other arenas, more than two thirds (69.4%) of California's submitted WCMSA proposals include extended funding for opioid medications. The statistic is startling considering that Medicare itself does not recommend using opioids for long-term use or chronic pain. The National Alliance of Medicare Set-Aside Professionals (NAMSAP) and the National Council of [...]
Arizona has taken a step toward fully resolving the medical coverage uncertainties that linger when its workers suffer injuries on the job. While many workers’ compensation (WC) injuries resolve relatively quickly, others take longer to respond to treatment in both the acute and post-acute phases, resulting in an extended recovery period and higher healthcare costs [...]
The Mandatory Second Payer Act (MSP) prohibits the Centers for Medicare and Medicaid Services (CMS or Medicare) from making injury-related payments for Medicare beneficiaries if there's another carrier or provider with a primary obligation to do so. When working to settle an injury claim by a Medicare beneficiary, the parties to the case must take [...]
Federal law protects the funding used by Medicare to cover healthcare costs of injured beneficiaries. When another entity - a primary insurance or healthcare plan (the primary payor, or PP) - has a legal obligation to cover those costs, the Medicare Secondary Payor Act (MSP) authorizes Medicare to obtain reimbursement from that PP entity of [...]
In almost all Workers’ Compensation (WC) cases, the Medicare Set-Aside account (MSA) includes a certain percentage of funding to cover the pharmaceutical expenses that are involved in many recovery protocols. MSAs related to more significant injuries such as loss of limbs or temporary or permanent disabilities often reserve the highest financial value specifically for drugs [...]
The Centers for Medicare and Medicaid Services (CMS) may be allowing an exception to the federal rule that asserts no state law will supersede its jurisdiction under any circumstances. An updated Reference Guide for Worker's Compensation Medicare Set-Aside Arrangements (WCMSA) version 2.6, suggests that CMS may be more willing than before to let state law [...]
Since October 2015, the recovery of Medicare health care payments from both Group (GHP) and Non-Group Health Providers (NGHP) has been managed by CGI Federal. CGI is the first contractor for the Centers for Medicare and Medicaid Services (CMS) Commercial Repayment Center (CRC), which collects back from third-party entities provisional payments made by Medicare on [...]
On October 1, 2017, the Centers for Medicare and Medicaid Services (CMS) was scheduled to stop paying for health care services that should, instead, be covered by parties deemed responsible for those damages pursuant to liability and no-fault insurance cases. In early 2017, the agency had announced that Medicare-beneficiary claimants in both liability and no-fault [...]
America is struggling to contain its nation-wide opioid epidemic, which has taken thousands of lives and crippled the lives of many thousands more. In mid-2016, President Obama signed the Comprehensive Addiction and Recovery Act (CARA), the first federal law designed to provide a comprehensive, balanced, and coordinated strategy to improve access to and treatment for [...]
