CMS Memos Address Medicare Set-Aside Arrangements

Medicare Set-Aside Blog on July 23, 2001 | Posted by


The first of CMS‘s published memos on Medicare Set-Aside arrangements (MSAs), this document explains why it’s important for Medicare to be put on notice of a primary payer in a Workers’ Compensation case.

Additionally, it addresses the circumstances of “conditional payments” made by Medicare for treatment that should be made by the primary payer to avoid the likelihood that Medicare pays claims before the MSA funds are exhausted.

This memo also discusses the difference between compromise and commutation cases and the impact on Medicare and MSAs.

Some of the questions and answers presented in this memo include:

Does the Medicare program have a claim against a lump sum WC payment before and individual’s Medicare entitlement?

If not, can the Medicare program give a written opinion on the sufficiency of a set-aside arrangement even if the individual is not as yet entitled to Medicare?

In WC cases involving injured individuals who are not yet Medicare beneficiaries, when must Medicare’s interests be considered before the parties can settle the case?

What are the criteria that Medicare uses to determine whether the amount of a lump sum or structured settlement has sufficiently taken its interests into account?

Some attorneys have indicated that a set-aside arrangement should only contemplate three to five years of estimated Medicare covered items or services. Would this be reasonable?


You may read the full memo/PDF file on their site.  



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