Coalition hopes bill will resolve Medicare set-aside delays, confusion
Rep. John Tanner, D-Tenn., sponsored H.R. 2641, which supporters said would address rampant problems with the review process of the Centers for Medicare and Medicaid Services, the federal agency responsible for the administration of Medicare. Similar legislation was introduced in 2007 but didn't garner enough support to move forward.
The current Medicare Secondary Payer Act was created to ensure that workers' comp settlements set aside enough money for medical care so that an injured employee wouldn't eventually file a claim with Medicare to seek additional treatment. To make sure Medicare isn't paying for treatment before a settlement runs dry, the CMS created a review process. Under the program, the agency reviews workers' comp settlements of more than $250,000 for employees who can become eligible for Medicare within 30 months.
Douglas Holmes, president of UWC-Strategic Services on Unemployment and Workers' Compensation and coordinator of the Coalition for Medicare Secondary Payer Reform, called the review process "convoluted" and detrimental to injured employees.
"The Medicare Secondary Payer and Workers' Compensation Settlement Act of 2009 will provide clear and consistent standards for CMS administrative process," he said. "CMS takes too long to review proposed set-asides, fails to provide consistent standards for determining amounts to be set aside, and provides no avenue to appeal CMS determinations. The process results in injured workers not receiving funds, additional costs for states and workers' compensation payers, and additional liability for employers, insurance carriers, and attorneys in contravention of the state workers' compensation exclusive remedy principle. A legislative solution to this problem is needed."
Ed Romano, president of the Workers Injury Law and Advocacy Group, agreed, saying that too often injured workers bear the brunt of the delays and reform is needed.
"This bill is about process improvement and fair treatment of all parties," he said. "In case after case, we hear of delays in approval, uncertainty of the amount to be reimbursed by injured workers, and changes in amounts to be set aside after settlements have already been approved."
Holmes said the current process also fails to provide effective recourse.
"There is no avenue to compel a timely decision or appeal a bad one," he said. "The legislation introduced by Rep. Tanner corrects this situation and many other costly problems and delays for the benefit of all parties involved, most importantly the injured workers."
The legislation has been referred to the House Committee on Ways and Means.
July 13, 2009
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