Legislation has been introduced in the House designed to resolve routine delays and confusion in the review of workers' compensation Medicare set-asides by the Centers for Medicare and Medicaid Services.

According to officials of the American Insurance Association, the legislation is supported by a broad coalition of groups representing injured workers, employers and insurance companies.

The officials say the issue has been festering since 2002, when the Centers for Medicare and Medicaid Services established a voluntary-review process aimed at ensuring that insurance is the primary payer for workers' compensation claims of people whose primary insurance is Medicare.

The legislation is the "The Medicare Secondary Payer and Workers' Compensation Settlement Agreement Act of 2012."

It is sponsored by Rep. Dave Reichert, R-Wash., and Rep. Mike Thompson, D-Calif.

"This legislation will provide clear and consistent standards for the CMS administrative process," says Melissa Shelk, vice president for federal affairs for the American Insurance Association.

"The current CMS set-aside-review process is both cumbersome and confusing," she says. "A legislative solution is needed to address stakeholders' concerns and to reform a broken system."

Shelk explains that, at this time, CMS takes too long to review proposed set-asides, fails to provide consistent standards for determining amounts to be set-aside, and provides no avenue to appeal CMS determinations.

"This is a pervasive workers' compensation claims problem that impacts all stakeholders, injured workers, employers, insurers and state workers' compensation agencies, nationwide," she says.

"Passage of this legislation will compel CMS to make timely coverage decisions and enable appeals when necessary," Shelk says.

"The bill also contains much needed provisions to address costly problems and delays that will benefit injured workers, employers and insurers alike," she said.

The bill has been referred to the House Ways and Means Committee.

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Industry Backing Workers' Comp Bill to Resolve CMS Delays

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