Washington, DC – The American Insurance Association’s (AIA) Medicare & Medicaid Task Force (Task Force) has submitted comments in response to the advance notice of proposed rulemaking (ANPRM), CMS-6047, entitled Medicare Secondary Payer (MSP) and “Future Medicals” to the Centers for Medicare & Medicaid Services (CMS). The ANPRM outlines standardized options that CMS is considering making available to beneficiaries and their representatives to clarify how they can meet their MSP obligations when future medical care is claimed or the settlement, judgment, award, or other payment releases claims for future medical care. The Task Force’s comments focus on the efficiency and effectiveness of the proposed options.
“Fortunately, the proposed options do not seek to place any obligations on an insurer or self- insured with respect to “future medicals” as there is no statutory authority permitting CMS to impose any obligation or granting it a right of recovery against an insurer or self-insured,” said Melissa Shelk, AIA vice president for federal affairs. “The seven options are therefore appropriately focused solely on beneficiaries and not on insurers and self-insureds.”
AIA’s Task Force urges CMS to explicitly include language to accurately reflect Congress’ clear intent in any rulemaking that the options presented are only for beneficiaries and their representatives and no obligation is imposed on insurers or self-insureds for medical expenses incurred after the date of a liability settlement.
“In order to avoid ambiguity, we call upon CMS to state unequivocally, through the rulemaking process that these options apply only to beneficiaries and not insurers or self-insureds” said Peter Foley, AIA vice president, claims administration. “CMS should take this opportunity reaffirm Congress’ intent, that no obligation is imposed on insurers and self-insureds for medical expenses incurred after the date of a liability settlement.”
Although insurers and self-insureds have no obligations with respect to future medicals, AIA’s Task Force can offer valuable insight on the tort system and the claims settlement process, because of the volume of claims the industry handles. CMS has chosen to consider multiple options for beneficiaries and their representatives to meet their obligations to protect Medicare’s interest with respect to MSP claims involving automobile, liability, workers compensation and no-fault insurance. The universe of claims while similar by line of business, vary dramatically in size, scope and the number of potential beneficiaries. CMS should be aware that the universe of liability claims subject to “future medicals” is very limited.
“AIA’s Task Force does not believe a single solution would meet the needs of the beneficiaries and that there must be multiple options available to beneficiaries,” said Foley. “Based on the ANPRM, the use of any option is solely at the election of a beneficiary; the rules should explicitly state that if they are appropriately used, the election constitutes a complete safe harbor for MSP purposes. Without a safe harbor, the rules could lead to further uncertainty for beneficiaries,” added Foley.
AIA’s Task Force suggests that no one option is the solution that will give beneficiaries and CMS their optimum outcome and no one option must be selected over all others. Although, some options as proposed would be ill-advised and would stymie the ability for insureds, self- insureds, and beneficiaries to handle and settle claims in a timely manner. For example, Option 4, to extend the flawed Workers’ Compensation Medicare Set-aside review process to liability claims must be rejected. The Task Force’s comments outlined are offered to CMS to help create fair, effective and efficient processes to handle the repayment of conditional payments along with considering “future medicals” of current beneficiaries.
AIA’s Task Force consists of 34 domestic and foreign insurance groups, trade associations, and other stakeholders representing over 300 major insurance companies that provide all lines of property-casualty insurance and write more than $159 billion annually in premiums.
A full copy of the Task Force’s comments is available here: AIA Comments on CMS-6047-ANPRM