The Centers for Medicare & Medicaid Services (CMS) announced this week that the Social Security Number Removal Initiative (SSNRI) will now be known as “New Medicare cards.” Regardless of what the program is called, the bottom line is that the old Social Security Number based Health Insurance Claim Number (HICN) will be replaced by a new Medicare Beneficiary Identifier (MBI). This is not exactly new news as the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 required CMS to remove Social Security Numbers from all Medicare cards by April 2019 and CMS announced the upcoming transition earlier year.
On July 13, 2017, the Board of Trustees of the Federal Old Age, Survivors Insurance and Federal Disability Insurance Trust Funds published its 2017 Annual Report. “The Old-Age, Survivors, and Disability Insurance (OASDI) program makes monthly income available to insured workers and their families at retirement, death, or disability. The OASDI program consists of two parts. Retired workers, their families, and survivors of deceased workers receive monthly benefits under the Old-Age and Survivors Insurance (OASI) program. Disabled workers and their families receive monthly benefits under the Disability Insurance (DI) program.”
Topics: Medicare Law
On July 13, 2017, the Boards of Trustees for the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds published its 2017 Annual Report. “The Medicare program has two separate trust funds, the Hospital Insurance Trust Fund (HI) and the Supplementary Medical Insurance Trust Fund (SMI). HI, otherwise known as Medicare Part A, helps pay for hospital, home health services following hospital stays, skilled nursing facility, and hospice care for the aged and disabled. SMI consists of Medicare Part B and Part D. Part B helps pay for physician, outpatient hospital, home health, and other services for the aged and disabled who have voluntarily enrolled.
Topics: Medicare Law
The Centers for Medicare & Medicaid Services (CMS) has put together a mechanism to receive and evaluate future medical and future prescription drug costs for inclusion in Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs). The Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) is a web-based application that allows attorneys, beneficiaries, claimants, insurance carriers, representative payees, and WCMSA vendors to create a work-in-progress case, submit WCMSA cases, perform case lookups, append documentation to a case, receive alerts relating to case activity, and now submit a re-review request.
On June 6, 2017, The Henry J. Kaiser Family Foundation published Medicare Advantage 2017 Spotlight: Enrollment Market Update. Written by Gretchen Jacobson and Tricia Newman from the Kaiser Family Foundation, Anthony Damico, an independent consultant, and Marsha Gold, a Senior Fellow Emeritus with Mathematica Policy Research and an independent consultant, the study highlights the fact that “Medicare Advantage plans have played an increasingly larger role in the Medicare program as the share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade.” The trend in enrollment growth is continuing in 2017, and has occurred despite reductions in payments to plans enacted by the Affordable Care Act of 2010 (ACA). The Data Spotlight “reviews national and state-level Medicare Advantage enrollment trends as of March 2017 and examines variations in enrollment by plan type and firm. It also analyzes the most recent data on premiums, out-of-pocket limits, and quality ratings.” The study can be found here.
By now, everyone involved with auto, liability, no-fault, and workers compensation claims is aware that the Medicare Secondary Payer Act (42 U.S.C. 1395y) was passed by Congress and signed into law by President Jimmy Carter in December 1980. However, the current Medicare Secondary Payer (MSP) compliance program we are all familiar with today didn’t really get started until the mid 1990’s, traced back to HIPPA’s Medicare Integrity Program.
Topics: Conditional Payments
As I previously blogged about on September 9, 2016, on August 30, 2016, the United States Court of Appeals for the 11th Circuit published its opinion in MSP Recovery, LLC v. Allstate Insurance Company, concluding that a contractual obligation, without a judgment, settlement, award, or other payment, can satisfy the “demonstrated responsibility” requirement of the private cause of action provided for by the Medicare Secondary Payer Act (MSP Act) at 42 U.S.C. §§ 1395y(b)(2)(B)(ii), (b)(3)(A). The court therefore allowed Medicare Advantage Plan assignee entities to seek double damages against no-fault, med-pay, PIP primary payers because of their refusal to reimburse Medicare advantage plan payments made related to the underlying covered claims.
On April 18, 2017, the United States District Court for the Northern District of Florida, Tallahassee Division, published its opinion on Gianinna Gallardo v. Elizabeth Dudek, Secretary of Florida Agency for Health Care Administration, concluding that Florida’s Medicaid reimbursement statute is preempted by federal Medicaid law. The court indicates that by allowing the Agency for Health Care Administration (AHCA)—Florida’s agency charged with administering Medicaid—to satisfy its lien from settlement funds allocated to both past and future medical expenses, Florida has run afoul of the federal Medicaid statute. The court also determines that the same is true for Florida’s Medicaid reimbursement statutory formula. Specifically, Florida’s reimbursement statute—which only allows the Medicaid recipient to rebut that formula-based allocation by presenting clear and convincing evidence that it is inaccurate—amounts to a quasi-irrebuttable presumption and thus conflicts with and is preempted by federal law.
Topics: Medicare Law
On March 21, 2017, the California Workers Compensation Appeals Board published its opinion on Fernando Muniz Villalpando v. Doherty Brothers; Martin Dusters; State Compensation Insurance Fund, concluding that in deciding whether to allow a claimant to go from having his MSA professionally administered to self-administering his own MSA account, the trial judge must examine the terms of the parties’ agreement, and whether it included any provision for a change of administration in the event the hired vendor ceased to operate or withdraw from providing the contracted services over the life of the agreement. The Appeals Board makes it clear that the trial judge should be provided the opportunity to consider the nature of the agreement between the employer/carrier, claimant, and vendor, and whether there is any provision for a change of administration, and if none, the nature of claimant’s contractual remedies.
Topics: Medicare Law