Industry, Plaintiff Lawyers Support Bill to Streamline Medicare Secondary Payment Enforcement

A House panel has passed legislation, sought by both industry groups and plaintiff lawyers, designed to streamline enforcement of the Medicare Secondary Payment (MSP) program.

The legislation, H.R. 1063, is the SMART Act, or The Strengthening Medicare and Repaying Taxpayers Act. It was reported out Tuesday by the Health Subcommittee of the House Energy & Commerce Committee, and was drafted by both Republican and Democratic members of the E&C Committee.

The bill would clarify industry-reporting requirements under legislation enacted in 2007, which requires reimbursement to Medicare for payments made to people who are also paid later through workers’ compensation or liability claims.

The MSP process is supposed to ensure Medicare is reimbursed for medical bills that are the responsibility of another party—such as an insurer or negligent party.

However, the legislation is somewhat changed from the bill originally introduced in March 2011 by Rep. Tim Murphy, R-Pa., and Rep. Ron Kind, D-Wis.

Among the revisions, the current bill would require the Centers for Medicare and Medicaid Services to maintain a web portal, accessible to Medicare beneficiaries, so that beneficiaries can determine when claims are paid, including those specific to an injury or accident.

Amendments to the bill also require CMS to provide a secure way for beneficiaries, or their representatives, to access the website.

Moreover, under the substitute, CMS requires all parties involved in a claim to notify CMS within 120 days of settlement, and for CMS to establish a process of appeals of payment determinations. Beneficiaries would have to send CMS a signed notification of intent to appeal under the revised bill.

The bill gives CMS 65 days to ensure the website is up to date with the latest claims.

A Senate companion bill, S. 1718, was introduced last October and now has 19 bipartisan co-sponsors. It is unclear whether the Senate will accept the amendments to the House bill.

Melissa Shelk, vice president for federal affairs for the American Insurance Association, says the bill, if enacted, “will improve and speed up claims settlements for Medicare beneficiaries while continuing to appropriately reimburse the Medicare trust fund.”

David Farber, a lawyer for the Medicare Advocacy Recovery Coalition (MARC), a group of large employers who earlier this year worked with members of the House to craft the original bill, also voiced support. “We are delighted Congress has chosen to take up this important legislation,” Farber says.


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