DRI Submits Formal Comments to Centers for Medicare and Medicaid Services on Proposed Rulemaking
DRI’s Medicare Secondary Payer Task Force has submitted a formal 13-page letter of comment and recommendation to the Centers for Medicare & Medicaid Services, Department of Health & Human Services. DRI represents 22,000 attorneys of the defense bar.
The letter addresses the Advanced Notice of Proposed Rulemaking with respect to the issue of future medical care in automobile and liability insurance (including self-insurance), no fault insurance, and workers’ compensation claims under the Medicare Secondary Payer Act (MSP). The goals that the Letter seeks to achieve in the rules are clarity, predictability and finality.
DRI’s comments are organized around four general points.
- DRI urges CMS to consider the great differences between settlement of liability claims and that of workers compensation and no-fault insurance claims before it looks to the latter two for guidance on liability rulemaking. It states that any rules promulgated must encourage settlement of claims and lawsuits. Rules must be clear, predictable, and allow finality or they will discourage settlement or even discourage claims themselves which works to the detriment of the Medicare Trust Fund. CMS should provide standardized future medical allocation methodology as part of any Final Rules it promulgates.
- CMS must revisit and update its existing rules related to recovery of conditional payments so that, among other things, parties will know the amount of conditional payments CMS will require to be reimbursed out of a settlement in advance of such settlement.
- DRI asserts that Medicare Set-Aside Arrangements (MSAs) are not necessary for every settlement and sets three characteristics that would make a settlement a candidate for one.
- Once a claim is resolved, a Responsible Reporting Entity (defendants, insurance carriers, and other entities) should have claim finality. Once a file is closed it should remain closed. The RRE should have no obligation to monitor whether an individual/beneficiary is complying with his or her future medicals obligations.
DRI suggests that CMS establish an appeals process for liability settlements in order to appeal CMS determinations.