01.27.09
Posted in Uncategorized, Medicare Set-aside, Medical Case Management, Workers' Compensation at 8:35 am by admin
Confused about proper compliance with the Medicare Secondary Payer Act? You’re not alone.
CMS recently revised the operating rules regarding Medicare Set-Asides. To answer frequent questions that this has raised, we created a reference sheet to clarify the different methods to comply with the MSP. Please note that the table is not designed to give specific advice on any settlement — it is designed to provide attorneys, risk managers and insurance executives with a guide to the legal requirements of the MSP and Medicare Set-asides. Please contact an attorney for specific legal advice concerning a settlement.
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01.26.09
Posted in Uncategorized, Medicare Set-aside, Workers' Compensation at 9:51 am by admin
The following post was written by Henry Kohnlein, attorney with Protocols, LLC. and co-founder of Sagrillo Kohnlein, LLC. Henry has litigated under the MSP. He has personally authored many detailed legal briefs on all aspects of the MSP for various clients. In addition, through Protocols, he has been involved with MSAs since 2001.
I am posting this due to the amount of inquiries I have received concerning the MSP statute of limitations (S.O.L.) and whether it applies to GHP only. This note is posted in hope to answer all the queries. It is important to remember this rule of statutory construction when analyzing a statute: If the language is unambiguous, then the plain language is enforced. If the language is ambiguous, then the purpose behind the statute is analyzed (legislative history, etc.). We discuss the first one here. Regardless of the answer to the above, either analysis arrives at the same conclusion: The MSP S.O.L. is THREE years from the date of the item or service is provided.
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Posted in Uncategorized, Life Care Planning, Medicare Set-aside, Medical Case Management, Special Needs Trust, Workers' Compensation at 9:11 am by admin
CMS is considering a ban on referenced-based pricing, which allows insurers to charge Medicare beneficiaries higher co-pays for brand-name drugs when generic equivalents are available. The increased cost usually equals the difference between the generic and the brand-name drug, but sometimes leaves beneficiaries paying the full price of the brand-name drug. Approximately 10% of insurers utilize the technique to encourage beneficiaries to select lower-cost generics.
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01.19.09
Posted in Uncategorized at 7:47 am by admin
On 1/6/09, the House voted to approve a package which included, among other things, elimination of the Medicare ‘trigger.’ The trigger comes into play when 45% of the Medicare program’s funding is drawn from general tax revenues for two consecutive years (rather than reserve funds). The trigger requires the president to submit a plan to slow spending and contain costs over a seven year period, in an attempt to make Medicare more financially stable. Last year marked the first time the trigger was invoked.
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01.12.09
Posted in Uncategorized, Life Care Planning, Medicare Set-aside, Medical Case Management, Special Needs Trust, Workers' Compensation at 8:45 am by admin
A recently-updated report by the National Council on Compensation Insurance (NCCI), shows that the growth of prescription drug costs continue to level off. Analyzing data through 2006 (the most recent data available), the report explains that the rate of increase of drug spending dropped by approximately half, from an annual average of 14 percent from 1996-2003 to 7.6 percent from 2003-2006.
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