In a press release the National Alliance of Medicare Set-aside Professionals (NAMSAP) claimed that the policies of the Centers for Medicare and Medicaid Services (CMS) “Institutionalized Opioid Abuse”.
“The Medicare Set-Aside program of the Centers for Medicare and Medicaid Services “encourages, intensifies and effectively orders long-term opioid use and abuse by Medicare beneficiaries. While the rest of the Federal government fights the opioid epidemic, CMS allocates funds for these dangerous and addictive drugs over the full life expectancy of a Medicare beneficiary at the same dosage and frequency that had been prescribed in the six to 12 months prior to MSA submission,” said NAMSAP Evidence Based Medicine Committee Co-Chair, Gary Patureau.
NAMSAP estimates that 70 percent of all CMS-approved MSAs that include prescription medication have life-long allocations for opioids. For years NAMSAP has tried to persuade CMS to apply evidence-based medical guidelines to its MSA allocation policy.
UWC is working with NAMSAP to persuade CMS to reform its policy and practices in determining amounts to be included in Medicare Set-Asides for prescription drugs and has coordinated the effort to develop legislation to more clearly set forth in statute that workers’ compensation law determines the amounts to be included for future medical in workers’ compensation settlement agreements. The CMS policy has resulted in many cases in significant differences in amounts to be set-aside for future medical under the applicable workers’ compensation law and under the administrative policy of CMS. Many settlements to the benefit of injured workers have not been finalized due to the CMS policy.
