Medicare Set-Aside Bill Gets Companion in U.S. House

Monday, July 30, 2018 | 0

Just five weeks after a bill was introduced in the U.S. Senate to streamline the frustrating approach to Medicare set-asides, a similar bill has been offered in the House of Representatives, which supporters say improves the chances of passage.

Doug Holmes
(UWC Strategic photo)

House Resolution 6619 was introduced last week by U.S. Rep. Dave Reichert, R-Washington. Like the Senate version, S. 3079, it aims to codify and clarify some aspects of the set-aside process that have been seen as inconsistent and burdensome to insurers and injured workers.

"We are pleased to now see introduction of legislation in both houses that would provide the improvements needed," said Doug Holmes, president of UWC Strategic Services, which consults and lobbies on workers' compensation legislation.

Holmes is also coordinator of the Coalition for Medicare Secondary Payer Reform, made up of insurance groups and claimants' attorneys who have worked for the measure for the past two years.

Both bills are titled the Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act, and seek to:

• Establish clear criteria in determining the amounts to be set aside in workers' compensation settlements. Parties have complained that in some cases a tentative settlement has been reached, only to have Medicare reject the set-aside amount.
• Create legal certainty in determining that state workers’ compensation laws are appropriately followed. Stakeholders have said Medicare contractors in some states have recognized the findings of some independent medical reviews on claims, but not others. The bills would require Medicare to recognize provisions of states' workers' comp laws.
• Provide a formal process of appeal to the Centers for Medicare and Medicaid Services. An informal process is in place now, but reviews are limited and are done at the discretion of the agency.
• Provide an optional direct payment of set-aside amounts to Medicare to speed payments, increase revenue for Medicare and provide certainty for injured workers. Instead of a worker having to make payments to Medicare for years, he would be able to pay the agency upfront.

The Senate bill is now in the Senate Finance Committee. The House version was assigned to the House Ways and Means Committee and to the Energy and Commerce Committee.