The Official Medicare Set Aside Blog And Information Resource

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

New Nebraska Legislation Allows Parties to Determine How Medicare’s Interests Should be Considered in Certain Settlements

Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on April 26, 2018
Posted by Jean S. Goldstein, JD

The Centers for Medicare & Medicaid Services (CMS) through various Memorandums and guides, has clearly stated that “[w]hile there are no statutory or regulatory provisions requiring that a (Workers’ Compensation Medicare Set Aside) WCMSA proposal be submitted to CMS for review, submission of a WCMSA proposal is a recommended process.”  Of significant note, the word […] Continue

CMS Issues Updates for Medicare Advantage and Prescription Drug Benefit Program: Will it Affect Your WCMSA?

CMS, Medicare Advantage, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on April 5, 2018
Posted by Jean S. Goldstein, JD

Earlier this week, CMS issued a policy change revising the Medicare Advantage Program (MAP) Part C regulations and Prescription Drug Benefit program (Part D).  The ultimate goal of the new policy is to ensure that individual’s treatment needs are met, while improving the quality of care and providing greater choices to MA enrollees.  The full […] Continue

Updated WCMSA Reference Guide Issued

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, WCRC on March 21, 2018
Posted by Jean S. Goldstein, JD

An updated Workers’ Compensation Medicare Set-Aside (WCMSA) reference guide has been issued.  The revised guide, version 2.7, can be found here. The revised WCMSA reference guide has two minor updates, which are: An updated phone number for the new Workers’ Compensation Review Contractor “WCRC” (1-833-295-3773 between 9am-5pm EST, Monday thru Friday); and A revised Confidentiality […] Continue