As I had advised in a past blog post, the receipt of Medicare benefits by a workers’ compensation claimant can significantly delay the settlement process in a workers’ compensation case. Under the Medicare Secondary Payer Act, anyone who is eligible for Medicare must contact Medicare prior to settling a workers’ compensation claim to determine if Medicare made payments for which another source (workers’ compensation) should be responsible. In the past, when we were required to obtain a statement of payments made by Medicare prior to a settlement, Medicare had no guidelines or time lines for their part in this process. Fortunately steps have been taken by the Federal Government to partially rectify this situation.
On January 10, 2013, President Obama signed the Strengthening Medicare and Repaying Taxpayers Act (SMART Act) into law.
The Secretary of Health and Human Services will soon be required to maintain a website that allows Medicare Beneficiaries to access information about claims and services paid by Medicare. Parties are required to provide Medicare with 120 days notice before they expect settlement of a workers’ compensation case to take place. Medicare will then have 65 days from the receipt of this notice to provide the Medicare reimbursement amount, a period which can be extended by 30 days by Medicare. After this time has expired, the parties can rely on the Medicare reimbursement amount obtained from the website if the settlement occurs within 120 days of the notice, and within three business days from the last download of the reimbursement amount from the website.
What does this mean to a workers’ compensation claimant? If their case settles and they receive their Workers’ Compensation Award during this 120 day period then the last statement of conditional payments made by Medicare that was downloaded during this period shall constitute the final amount subject to recovery by Medicare. This is a joy to behold. Before this law was made, we would have to wait months for a statement of conditional payments. Even after we received the statement there was no guarantee that Medicare would then not issue another statement after the settlement asking for more money to be reimbursed to Medicare than was requested prior to settlement. The process as it stands now is a nightmare for workers and their attorneys. The Secretary of Health and Human Services has until September 10, 2013 to implement these regulations. Congratulations to Congress for passing this SMART Act.
Please contact the Workers’ Compensation Team at Stark and Stark with any questions.