An important piece of legislation was recently introduced in Congress that, if passed, will change the way that Medicare secondary payer rules for certain claims, including workers’ compensation, are applied. The legislation is called the “Strengthening Medicare And Repaying Taxpayers Act of 2011 (a/k/a HR 1063 or the SMART Act) and was sponsored by Congressmen Tim Murphy (R-PA) and Ronald Kind (D-WI).
According to this blog post from RiskandInsurance.com, the Act would:
- Set a process and time frames for the Centers for Medicare and Medicaid Services to respond to requests for statements of conditional payment reimbursement amounts or waive the right to collect.
- Establish an annual threshold for settlements to ensure CMS does not spend more on collecting than it stands to recover.
- Implement safe harbors for reporting requirements.
- Relax the requirement to obtain Social Security numbers of beneficiaries.
- Set a statute of limitations for CMS to file an action after a notice of settlement.
As explained in the blog post, for the most part, insurance trade associations support the SMART Act–particularly the last provision which establishes a 3 year statute of limitations for CMS to file an action:
Workers’ comp stakeholders are also pleased with a provision that sets a three-year limit for CMS to bring legal action. “This is something where, for many insurers and employers, they may not have records going back that far,” Holmes said. “This puts a reasonable time frame on legal actions to be brought by the U.S.”
While insurers support the current version of the SMART Act, its effect on workers remains to be seen. Only after the final version is passed will we know how it will change secondary payer rules for workers’ compensation claims. Until then, we can only wait and see how the chips may fall.