CMS Plans to Propose “Guidance” for future medical under Workers’ Compensation

The Centers for Medicare and Medicaid Services (CMS) released its 2019 regulatory agenda including a Notice of Proposed Rulemaking for a rule that would provide guidance for Medicare beneficiaries with respect to health care choices and Medicare Secondary Payer. The text of the notice  is provided below with Notice of Proposed Rulemaking projected for September 2019.

The proposal suggests that it is “economically significant” and that one of the purposes is “protecting the Medicare Trust Fund”.  The description goes on to imply that Medicare should provide its beneficiaries with guidance to help them make choices regarding their future medical care expenses when they receive automobile and liability insurance (including self-insurance), no fault insurance, and workers’ compensation settlements, judgments, awards, or payments, and need to satisfy their Medicare Secondary Payer (MSP) obligations.

CMS already provides Medicare beneficiaries with information about health care choices offered through Medicare.

CMS does not currently provide guidance to help Medicare beneficiaries make choices regarding their future medical care expenses when they receive automobile and liability insurance (including self-insurance), no fault insurance, and workers’ compensation settlements. There is a good reason for this; CMS does not have authority to determine or responsibility for future medical care expenses under these plans and programs.

The fact that the rule is deemed to be “economically significant” and is being proposed to “protect the Medicare Trust Fund” indicates that there is an expectation that implementation would have a positive impact on the Medicare Trust Fund. This could mean that CMS projects that there would be  increased recovery from beneficiaries and plans.

We are gathering additional information about the CMS intention including this rule on its agenda for September of 2019. If you have observations, comments or thoughts please let me know.

>> View Notice of Proposed Rule (Web)

>> View Notice of Proposed Rule (PDF)