The Official Medicare Set Aside Blog And Information Resource

CMS to Begin Utilizing 2015 Life Table

CMS, Medicare Set-Asides, MSP News on December 11, 2018
Posted by Jean S. Goldstein, JD

Starting January 5, 2019, the Centers for Medicare and Medicaid Services (CMS) will begin using the CDC’s “Table 1: Life Table for the total population: United States, 2015” for Workers’ Compensation Medicare Set Aside (WCMSA) life expectancy calculations.  This means that for any WCMSA proposal received by CMS, or where any WCMSA case is reopened […] Continue

CMS Adds a Proposed Rule – Will it Affect Your Workers’ Compensation and Liability Claims?

CMS, Medicare Set-Asides, MSP News on December 10, 2018
Posted by Jean S. Goldstein, JD

The Centers for Medicare & Medicaid Services (CMS) recently added an item to the Unified Agenda, which may have an impact on your claims.  The Unified Agenda of Federal Regulatory and Deregulatory actions is a semiannual compilation of information about regulations under development by federal agencies published in the spring and fall.  The item added […] Continue

Structured Settlements in the Field

CMS, Medicare Set-Asides, Structured Settlements on October 24, 2018
Posted by Katharine Rupp, JD

In our last blog about structured settlements we reviewed the basics of what a structured settlement is and why you would want to structure a settlement. However, the benefits of structuring a settlement are best shown through real life examples. Below are three scenarios in which MEDVAL was able to provide creative settlement solutions utilizing […] Continue

Inclusion of Lyrica in Workers’ Compensation Medicare Set-Aside Arrangements

Medicare Set-Asides, Rx/Pharmacy, WCRC on October 11, 2018
Posted by Complex Claims Division

Lyrica (pregabalin) is an analog of the neurotransmitter gamma-aminobutryic acid, or GABA. Within the brain and nervous system, GABA plays an important role in behavior, cognition and the body’s response to stressful situations. A deficiency in naturally-occurring levels of GABA has been linked to conditions such as schizophrenia, depression, anxiety and various sleep disorders.  While […] Continue

Updated Guides Issued: WCMSA Reference Guide and Section 111 Reporting Guide

CMS, Medicare Set-Asides, MSP News on October 4, 2018
Posted by Jean S. Goldstein, JD

An updated Workers’ Compensation Medicare Set-Aside (WCMSA) reference guide has been issued.  The revised guide, version 2.8, can be found here. The revised WCMSA reference guide includes the following updates: Fields formerly labeled as “HICN” have been relabeled as “Medicare ID” and can accept either an Health Insurance Claim Number (HICN) or the new Medicare Beneficiary […] Continue

FDA Approves Consensi™: A Novel Combination but a Conundrum for the Medicare Set-Aside

FDA, Medicare Set-Asides, Rx/Pharmacy on September 11, 2018
Posted by Complex Claims Division

On May 31st, the FDA approved Kitov Pharma’s application for Consensi™. Consensi is a unique combination product containing amlodipine, a calcium channel blocker used for the treatment of hypertension, and celecoxib, a non-steroidal anti-inflammatory used for the treatment of osteoarthritis. The product’s labeling will include a single indication for patients for whom treatment with amlodipine […] Continue

Another MSP Case Invades a Jurisdiction: The Sixth… This Time.

Medicare Advantage, Medicare Set-Asides, MSP Litigation on July 19, 2018
Posted by Jean S. Goldstein, JD

Another Medicare Secondary Payer (MSP) case involving the well-known entities, MAO-MSO, Recovery II, LLC MSP Recovery, LLC and MSPA Claims 1, LLC (“Plaintiffs”) has arisen out of the Sixth Circuit.[1] (MAO-MSO Recovery II, LLC v. Progressive Corp., No. 1:17CV390, 2018 U.S. Dist. LEXIS 119046, (N.D. Ohio July 17, 2018).  This recent opinion is issued in […] Continue

Professional Administration: The Last Piece of the MSP Compliance Puzzle

CMS, Medicare Set-Asides, Professional Administration on June 26, 2018
Posted by Jean S. Goldstein, JD

It has been nearly one year since the Centers for Medicare & Medicaid Services (CMS) first released a revised Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide,[1] which addressed one of the lesser discussed topics in Medicare Secondary Payer (MSP) compliance: professional administration.  Specifically, the revised guide included the following statement: “[a]lthough beneficiaries may act as […] Continue

Senate Bill 3079, Legislation to Band-Aid the Medicare Set-Aside Process Has Been Introduced

Legislation, Medicare Set-Asides, MSP News on June 21, 2018
Posted by Jean S. Goldstein, JD

You may recall in 2014, Senators Portman and Nelson introduced a Senate Bill, “[t]o amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers’ compensation settlement agreements and qualified Medicare set-aside provisions.”  However, the legislation failed and never made it out of the Committee on […] Continue

Arizona SB 1100 Impacts “Full and Final Settlements” of Accepted Claims

Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, State Regulations on May 17, 2018
Posted by Jean S. Goldstein, JD

Last month, Arizona Governor, Doug Ducey signed Senate Bill 1100 (SB 1100), which is a modification to the legislation allowing for full and final settlements.[1]  You may recall our initial blog on the ability to finally fully settle and close out a workers’ compensation claim in Arizona, under Senate Bill 1332 (SB 1332), as well […] Continue