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Legislative & Regulatory

Perennial WCMSA Legislation Re-Introduced

Nearly identical to past versions, recent Workers’ Compensation Medicare Set Aside (WCMSA) legislation has been again introduced in Congress. The proposed legislation (HR 4161), introduced on August 2, 2019 is titled, the “Coordination of Medicare Payments and Worker's Compensation Act.” It is sponsored by Rep. Mike Thompson [D-CA]. Full text of the proposed legislation can be found here.

Prior versions of the proposed law haven’t made it far in the legislative process and this iteration will also likely die in Congress.  A brief synopsis of elements that the legislation proposes:

  • Definitions for workers’ compensation concepts, including workers’ compensation claimants, laws or plans, payers and settlement agreements
  • A vague outline of when an MSA would satisfy Medicare Secondary Payer (MSP) obligations
  • Codifies MSA concepts, including the terms Medicare Set Aside, the satisfaction of an MSA, items and services to be included and payment requirements based upon the applicable workers’ compensation state fee schedule
  • Allows for an optional proportional adjustment to MSAs in denied/disputed cases by “applying a percentage reduction to the [MSA] amount for the total settlement amount that could have been payable.” This percentage reduction would need to be equal to the denied, disputed, or contested percentage of the total settlement
  • Provides for an optional / voluntary MSA approval process requiring Medicare to give notice within 60 days. There are no dollar amount thresholds indicated
  • Allows for parties, within 60 days of an initial decision/determination, to challenge this through administrative appeals by a request for reconsideration, an ALJ hearing and followed by judicial review
  • Has an option for direct deposit of the MSA to Medicare upon written consent
  • Allows for election of either beneficiary or professional administration
  • Increased deference with respect to the treatment of workers’ compensation law
  • If passed, this would affect any workers’ compensation settlement on or after January 1, 2020

Ametros will be tracking this proposed legislation closely and how it may impact professional administration and the WCMSA program. A forthcoming piece by Ametros will also be issued that will cover the implications of a potential direct pay option as referenced above. 

If you have any questions, please contact Shawn Deane, General Counsel: [email protected]

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