LMSA Timeline: What We Know So Far

It’s October 13^th, and we still haven’t heard word on the liability review process. The memo that was expected from the Centers for Medicare and Medicaid Services (CMS) has not been released. It was anticipated that on October 2nd, CMS would begin using data collected from insurers to deny paying for medical care that was included in a settlement. It seems that after CMS chose a new workers’ compensation review contractor (WCRC), two of the contractors that were not chosen filed a formal protest with the Government Accountability Office (G2XchangeHealth). This protest has caused a stop work order, preventing the liability review process from moving forward. The protest is expected to be resolved before December 21^st 2017. It is expected that the newly hired review contractor will be responsible for implementing the liability MSA (LMSA) review. These developments could alter the way future medical care, MSAs and settlements are treated in 2018. While we wait for developments, we take a look at the timeline so far, and the pieces that are being put into place by CMS that could potentially be leading to more liability MSAs, and ensuring post-settlement future medical treatments are paid by the right parties. On June 9^th, the Medicare Learning Network released an article informing providers that the Medicare Administrative Contractors (MACs) will begin to deny payment for items or services that should be paid from a liability LMSA or no-fault Medicare set aside arrangements (NFMSAs) (MLN Matters). On July 10^th, CMS released the updated Workers’ Compensation Reference Guide, including the addition to “highly recommend” professional administration of workers compensation Medicare set asides (WCMSAs). September 1^st, CMS announces that Capitol Bridge LLC will be the new Workers’ Compensation Review Contractor. Based on CMS’ request for proposal, we know the budget increase for the contractor is due to the additional work required to review liability Medicare set asides, or LMSAs. On September 19^th, the Medicare Learning Networks released articles informing providers on how to bill patients with a WCMSA or LMSA. This article was rescinded on October 3^rd. While historically, changes have been made slowly by CMS, as you can see there has been significant activity, announcements and changes ultimately putting the pieces into place to ensure proper payment of MSAs, and to set the framework for a LMSA program perhaps similar to the WCMSA program. So how will these changes affect you? Healthcare Providers – Medicare will be more closely watching and denying treatments that should be paid for by LMSA funds. They will be expecting more providers to be vigilant in denying services and properly billing to Medicare or LMSA funds. Insurers – Expect a more formal review process for LMSAs, similar to the voluntary review process for WCMSAs. Beneficiaries – Be prepared for more denials and stricter policies around reporting to Medicare and proof of exhaustion before Medicare will step in as the primary payor. Attorneys – With all of these changes, it is important for you to make sure your client is protected. At Ametros, we have many liability and workers’ compensation MSAs under management, and we help ensure injured parties have the resources and support they need after settlement. Have questions about LMSAs and how administration can help you?