Filed Under:Markets, Workers Compensation

Insurance Reps Push for Action on Medicare Secondary Payment Bills by Year-End

Insurance and related industries are seeking to win support in the waning days of the current Congress for two pieces of legislation dealing with payment of injured worker claims to people whose primary insurance is Medicare.

Officials of both the American Insurance Association and the Property Casualty Insurers Association of America are urging action on the bills this year.

One bill, which has been on the congressional radar screen for several years, has already passed a House committee and is seen by supporters as having a good chance of making it through the House and Senate.

The bill is H.R. 1063, the SMART Act, or The Strengthening Medicare and Repaying Taxpayers Act. It deals with issues related to Sec. 111 of the Medicare Secondary Payment Act.

Specifically, it deals with mandates for providing timely information on conditional payments, penalties and statutes of limitations when claims are reported to the Centers for Medicare and Medicaid Services by insurers and self-insured and third-party payers on no-fault auto-insurance claims, workers’ compensation claims, and claims under liability insurance.

Industry officials are hoping that, in the waning days of Congress, work on H.R. 1063 in Ways and Means can be done in tandem with the second bill, H.R. 5284, the Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2012.

That bill was introduced earlier this year in the House by Rep. Dave Reichert, R-Wash., and Rep. Mike Thompson, D-Calif.

Nathaniel Wienecke, PCI senior vice president, Wednesday asked officials of the Senate Finance Committee and the House Ways and Means Committee if it could act on the bill this year.

H.R. 5284 deals only with workers’ compensation claims, and seeks to establish clear and consistent rules for workers’ compensation set-asides for claimants covered by Medicare.

Currently, workers’ compensation claims that overlap with Medicare coverage are subject to lengthy, cumbersome review by the Centers for Medicare and Medicaid Services to establish the proper “set-side” coverage amounts for future medical expenses, according to PCI officials.

“This commonsense legislation will bring more clarity and consistency to the Medicare set-aside administrative process,” says Tom Litjen, VP Federal Government Affairs for PCI.

 “This bill will benefit injured workers, employers, and insurers, by eliminating costly delays in the federal government’s review process for workers compensation claims of Medicare beneficiaries,” he adds.

Melissa Shelk, AIA vice president of federal affairs, says, “AIA has been a leader on this issue and continues to advocate for passage of HR 5284.”

  In addition, Shelk says, “We also support 1063, which will facilitate property-casualty insurers' compliance with Medicare Secondary Payment Act reporting."

A lobbyist employed by employers and third-party payers who have urging overhaul of current policies, says the bill has a “realistic” chance of passage this year even though no action on it is evident either in the House or Senate.

The lobbyist, who asked not to be named, says the bill was written with the support of both Democrats and Republicans and satisfies all interested parties, action could still happen while work continues on the “fiscal cliff” package is completed.

“We are all waiting to get the cliff discussions out of the way, but during this lull there is a chance for real work to happen,” he says.

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