Bipartisan PAID Act Introduced in the U.S. House of Representatives
Clearer Framework for Information Sharing in Medicare and Medicaid Reimbursement Will Benefit Beneficiaries, Taxpayers, Insurers and Self-Insureds
CHICAGO – (May 21, 2018)— In what stakeholders are terming a “commonsense reform,” Representatives Gus Bilirakis (R-FL) and Ron Kind (D-WI) have introduced the Provide Accurate Information Directly Act (PAID) in the U.S. House of Representatives. Specifically, the measure is designed to improve the Medicare Secondary Payer (MSP) and Medicaid Third Party Liability (TPL) statute.
Theoretically, MSP policy is meant to ensure that the Medicare and Medicaid programs do not reimburse healthcare expenses for which some other entity is legally responsible. In practice, however, that intent is thwarted by the unavailability of critical information that prevents the recapture of improper payments. The PAID Act will significantly improve the efficiency of the current system with a clear framework for communication among all stakeholders involved.
“The PAID Act includes certain reforms that DRI has long advocated to create efficiencies by eliminating uncertainty,” said John R. Kouris, DRI Executive Director. “We commend Representatives Bilirakis and Kind for their hard and skillful work in proposing and advancing those reforms.”
The PAID Act will create a clear and functional MSP system for Medicare Advantage (MA), Medicare Part D, and Medicaid, benefitting beneficiaries and the programs alike
Currently, settling parties have no way to find out which MA Plan, Part D Plan, or Medicaid program the beneficiary is in, and therefore, cannot coordinate benefits or repay what is owed.
The PAID Act mandates the sharing of certain information between the Centers for Medicare and Medicaid Services (CMS) and settling parties — specifically, whether the beneficiary is enrolled in MA, Part D, or the Medicaid program. By simply being provided the name and identity of the plan and the dates of coverage, settling parties will be able to resolve and repay MSP or TPL liabilities associated with settlements, judgments, or awards thus effecting significant savings to the programs and the taxpayers.
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