In follow up to CMS notices from 9/30

Medicare Set-Aside Blog on October 3, 2011 | Posted by

As you recall, CMS announced several significant policy changes on Friday morning then quickly removed any evidence of the notice until after the close of the business day. Below you will find summaries of the various announcements with links to the Alerts. Stay tuned because the announcement alludes to more to come.


1. Liability TPOC reporting delays Alert – The table in the Alert itself is the best summary available. https://www.cms.gov/MandatoryInsRep/Downloads/RevNGHPTimelineTPOC.pdf
 
a. >$100K, TPOC date on or after 10/1/11
b. >$50K, TPOC date on or after 4/1/12
c. >$25K, TPOC date on or after 7/1/12
d. > minimum threshold, TPOC date on or after 10/1/12. Minimum thresholds are:
     i. ≤$5K, TPOC date prior to 1/1/13, exempt from reporting
     ii. ≤$2K, TPOC date 1/1/13 to 12/31/13, exempt from reporting
     iii. ≤$600, TPOC date 1/1/14 to 12/31/14, exempt from reporting
     iv. No threshold for claims where last TPOC date is 1/1/15 and subsequent.
 
2. Exposure, Ingestion, Implantation 12/5/80 Alert –
http://www.cms.gov/COBGeneralInformation/Downloads/NGHPExpIngImplant.pdf


Essentially states that as long as all exposure/ingestion/implantation occurred pre-12/5/80 and nothing on or after 12/5/80 is claimed or releasedthen CMS will not assert a recovery claim and reporting is not required. Allows an exception for a broad general release that effectively released exposure/ingestion on or after 12/5/80. Based on what I have heard on CMS calls, the RRE should be able to prove that despite the broad general release, the fact is that no exposure occurred on or after 12/5/80. 
 
3. Qualified Settlement Funds Alert –
https://www.cms.gov/MandatoryInsRep/Downloads/NGHPReportingException.pdf
 
a. QSFs are NOT RREs
b. Limited Section 111 reporting exception if:
    i. There is a liability insurance TPOC with no ORM; 
    ii. The TPOC is issued by a QSF under Section 468B of the IRC in connection with a bankruptcy; AND
    iii. The funds being issued were paid into the trust prior to 10/1/11.
 
4. Future Medicals in Liability Settlements Alert –
http://www.cms.gov/COBGeneralInformation/Downloads/FutureMedicals.pdf


This is significant mainly because it is the first written policy we have seen from CMS regarding LMSAs. CMS recognizes that if the treating physician provides written certification that all injury-related treatment has been completed as of the dated of settlement, then CMS’ position will be that Medicare’s interest with respect to future medicals has been satisfied. The certification need not be submitted to CMS and CMS will not provide a verification letter in response to a physician certification thattreatment has concluded. CMS encourages that the beneficiary or their representative “maintain the physician’s certification.”
 
Coming Soon ( https://www.cms.gov/MandatoryInsRep/04_Whats_New.asp#TopOfPage )


1. MSPRC self-service phone service.
2. October 2011 Alert (by 10/21/11) re: liability cases ≤$5K having the option of paying a fixed percentage through the MSPRC.
3. MSPRC portal to allow online access to facilitate recovery process.
4. Option to allow for immediate payment for FUTURE medical claimed/released in a settlement.
5. Ability to obtain a conditional payment amount prior to settlement in some situations.