The marketing team at Ametros has been releasing #FunFriday posts and inquired, as part of this, if I’d be willing to participate in an “Ask Me Anything.” This is where anyone can ask me anything they want. The rules were simple: “Whether it’s about Ametros, professional administration, MSAs, MSP, or even his favorite movies, ask away!” Marketing compiled all the questions and responses and broke them down into two parts: industry-related and personal.
Part I: Industry-Related
Question: “When will Medicare provide guidance on Liability Medicare Set Asides?”
Response:
As some may recall, in 2012, rulemaking for Liability Medicare Set Asides (LMSAs) was initiated. However, that process was subsequently discontinued in 2014. Prior to that, two memos issued on the topic, including the May 25, 2011 “Stalcup Memo” out of the Dallas Regional Office, and a CMS memo dated September 29, 2011, that indicated when an LMSA was not necessary (when a treating physician certifies in writing that no further Medicare-covered treatment related to the injury has been completed as of the date of the settlement and that future treatment will not be required). In the solicitation and statement of work for the Workers’ Compensation Review Contractor (WCRC) from 2016 and 2017, there was an indication that the contractor needed the ability to review LMSAs. This all is telling, as the Centers for Medicare & Medicaid Services (CMS) has taken the general position their interests should be considered when resolving a liability claim.
We’re still waiting on the issuance of proposed rules on LMSAs. It’s widely anticipated that CMS’ notice on rulemaking for future medicals (released at the close of 2018) will address LMSAs. The dates for issuing the proposed rules were extended – currently to February of 2020. However, the February date has come and gone. With the recent release of Sec. 111 proposed rules regarding when CMS would levy civil money penalties for non-compliance, and the public comment period ending on April 1, 2020, CMS may not want two major MSP rulemaking events occurring simultaneously. At this juncture, any guess on a date for proposed rules around LMSAs would be purely speculative.
Question: “What if I submit an MSA to Medicare as a lump-sum and self-admin, but after approval we want to change it to a structure and use Ametros for professional admin?”
Response: The process for each is a little different and I’ll address each in turn, respectively.
Change from Lump-Sum to Structure
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- The submitter (entity who is authorized and sent in the MSA submission) or the claimant or their authorized representative, would submit a letter to the WCRC, signed by the claimant, requesting a change from lump-sum to an annuity. If the claimant is represented, the letter should also be signed by their attorney. The information should include reference to the Case Control Number so CMS can identify it. Importantly, the letter should contain the funding figures, including the seed and annuity amounts. It is critical the parties notify CMS as it may affect how temporary exhaustion is reported and to ensure continuity of coverage.
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Learn More about Professional Administration & Structured Settlements
Change from Self-Admin to Professional Administration
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- There isn’t the same formal process here and CMS’s approval is not necessary. However, CMS should be notified to ensure the professional administrator is associated with the case on record with CMS. This will also allow the administrator to submit electronic attestation. A letter can be sent to the BCRC indicating the administrator’s information and that it will be professionally administered. A draft or finalized copy of the professional administration agreement can also be sent or an authorized user can upload it to the Workers’ Compensation Medicare Set Aside Portal (WCMSAP).
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Part II: Personal
Question: “Which beer do you bring and share when meeting your hero?”
Response:
My favorite beer is called Julius, by Treehouse Brewing Co. in Charlton, Massachusetts. My real-life hero is my Dad. He lives out in California, but I’ve brought him a Julius and shared with him! However, I know who sent this question in and I’ll play along. For a fictitious superhero, I would share an English Ale with Thor!
Question: “Why are the New England Patriots changing uniforms?”
Response:
My guess would be that with Tom Brady’s departure they want a fresh look. It seems a lot of NFL teams are revamping their uniforms and logos. I wonder what the NFL season will look like in 2020.
Question: “Who would you like to swap places with for a day?”
Response:
Me 7 years ago, so I could get one day again with my kids when they were little.
Question: “What’s your favorite part about working at Ametros?”
Response:
The team there. The people are awesome!
Question: “1) Who will be the Patriots starting QB on game 1 next year? 2) How Many games will NE win in the regular season? 3) Who will win?”
Response:
1) Jarrett Stidham; 2) 10; 3) New England Patriots will win, of course!
