Archive for the ‘Medicare’ Category

In the waning days of 2007, with the cost of health care continually escalating and with more and more of the costs being borne by the United States Government, Congress passed and President Bush signed into law the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). With the stroke of his pen, the President created a responsibility for self insured organizations, liability insurers, group health plans and non-group health plans that pay bodily injury claims to insure that the Medicare system is protected from bearing the costs of current and future medical expenses if those expenses are the primary responsibility of an entity other than Medicare. Entities making such payments are known as RREs. Read more

Roberto Ceniceros

The U.S. government’s first-of-its-kind lawsuit against all parties that settled a pollution liability case signals Medicare’s aggressive push to make sure it does not pay medical expenses when others are to be the primary sources of payment, observers say.

The suit filed Dec. 1, 2009, cites Medicare Secondary Payer provisions in federal law that allow Medicare to recover past and future medical expenses from all parties—insured and self-insured—involved in a liability claims award or settlement that includes Medicare-eligible individuals. Read more

The Office of the Actuary of the Centers for Medicare & Medicaid Services (CMS) recently released two new memoranda on the “Patient Protection and Affordable Care Act,” as approved by the Senate on December 24.

In one memorandum, CMS Chief Actuary Richard Foster discusses the impact the bill would have on costs, savings, and coverage. The analysis estimates that the Senate-passed bill would increase national health expenditures, from 2010 through 2019, by a total of $222 billion, or 0.6 percent, over the updated baseline projection that CMS released in June 2009. It further projects that the bill’s coverage provisions would cost an estimated $882 billion over the first ten years. Also, an estimated 34 million currently uninsured people would gain comprehensive coverage by 2019 through the health insurance exchanges, their employers, or Medicaid. Read more

By Alvin D. Lurie

January 8, 2010

Copyright 2010, A.D. Lurie

Benefitslink.com

It should first be explained that this article was originally prepared for publication in the third week of December (2009), at which time the Senate was locked in fierce dispute between the Democrats and the Republicans over the health care reform bill, H.R. 3590 (grandiosely titled the Patient Protection and Affordable Care Act). The bill seemed headed for a certain filibuster from a solid 40-person Republican bloc, the principal bone of contention being what had come to be called “the public plan option”, i.e., a government-run insurance plan to be offered to compete with private insurance company plans as a health care benefit enhancement and cost containment measure, the theory being this would force the private insurers to meet the government benefit standards and premium pricing rates. Read more

With clock ticking, Senate measure proposals in flux

Jerry Geisel

WASHINGTON—Health care reform legislation is inching its way to a Senate floor vote as Democratic leaders continue to wheel and deal to get the support needed to assure passage. Read more

Reid Still Looking For 60 Votes

Majority Leader Harry Reid (D-NV) is still seeking support from a number of Senate Democrats who have yet committed to support his healthcare reform package. As reported, a compromise package was negotiated between a select group of liberal and moderate Senate Democrats, which Reid has sent to the Congressional Budget Office (CBO) for an official cost and coverage estimate. Those results are expected within the next few days. It is likely that the cost estimate of the compromise will come in at an increased cost to the overall healthcare reform package. The provision that will most significantly lead to the increase will be the proposed lower of Medicare eligibility to 55 years of age. Medicare premiums are significantly higher that those expected in the proposed exchanges, so any subsidies for eligible low-income workers or early retirees will be more expensive for taxpayers. The expected increase in cost as well as the expansion of a public entitlement program raises the most concern among non-committed Senate moderates. Read more

As was reported, a loose and tentative compromise has been reached between Senate liberals Democrats and Senate moderate Democrats on the conceptual size, scope and structure of the proposed government-run healthcare plan. To date, Majority Leader Reid has made no language available, even to those Senators involved in the negotiations. The Majority Leader has sent the proposal to the Congressional Budget Office to get an official estimate on cost and coverage. Those numbers are expected to be released by CBO next Monday. At that point, the Majority leader will shop both the results and the language to Senators to gage if he has the necessary 60 votes. Once he has 60 firm commitments, he will call for a series of cloture votes to end debate. Once all the necessary cloture votes have been approved, Reid would then call for a vote on final passage. As final passage vote can not be filabustered, it only needs a simple majority to pass. Read more

Effort to curb Medicare costs raises questions

Roberto Ceniceros

Insurers and self-insured employers face a Dec. 31 deadline to register with a federal agency, but numerous questions remain about what workers compensation and liability claims data must be fed into the Medicare system, several experts say. Read more

Although Medicare is not the main focus of current health reform legislation, the bill recently passed by the House—H.R. 3962, America’s Affordable Health Choices Act of 2009—and the bill before the Senate—H.R. 3590, Patient Protection and Affordable Care Act—include a number of provisions that would affect Medicare program expenditures. Read more

This brief compares the major Medicare provisions relating to benefit changes, Medicare Advantage, the Medicare prescription drug benefit, physician and other provider payment reforms, and other health system reforms in the House legislation approved by the full House on November 7, 2009 and the Senate Leadership Bill as released on Nov. 19, 2009. The document will be updated to incorporate major changes made during the legislative process.

Summary of House and Senate Reform Bills

Well drafted subrogation provisions will state that any allocation of tort settlement or judgments to reimburse non-medical losses – such as earnings lost – will not be binding on the plan. If that is stated, settlements or judgments won’t preclude the plan participant’s obligation to reimburse the plan. However, that’s not the necessarily the case when Medicare seeks to be reimbursed for the medical benefits that it paid. Indeed, contrary to the usual approach taken by privately sponsored health plans, the Medicare Secondary Payer (MSP) law on which Medicare’s right to reimbursement is based does not contain such a provision. Read more

Reporting to Medicare

The purpose of these reporting requirements is to enable the Centers for Medicare & Medicaid Services (CMS) to determine whether those covered by Medicare are also covered by other insurance that, by law, must pay primary to Medicare. Read more

John Cattie of the Garretson Firm, recently informed us about his firm’s “Learning and Resource Center” webpage which provides current material related to MMSEA and MSAs. To learn more about MMSEA and MSAs go to http://www.garretsonfirm.com/garretson/resources/

by Janet Adamy and Elizabeth Williamson, The Wall Street Journal, www.wsj.com

Medical-device makers are adamant that U.S. health care needs fixing. They’re equally adamant that they shouldn’t have to pay for it.

“If you’re looking for savings, don’t come at us,” says Tim Trysla, a top industry representative. He has marched into the offices of 120 lawmakers, sometimes with General Electric Co. officials in tow, to argue that the government already provides so little reimbursement for high-tech medical scans that it shouldn’t chop payments further. Read more

by, Malcolm B. Futhey III and Carrie Eaker Kerley
Lawrence & Russell, LLP, Memphis, Tennessee

Medicare statutes and regulations provide for a right of subrogation through the Medicare Secondary Payer provisions. However, the scope and strength of this right for Medicare Advantage organizations have been cast into confusion given Care Choices HMO v. Engstrom, 330 F.3d 786 (6th Cir. 2003). To complicate the matter, attorneys for members and liable insurers constantly present arguments that even further misconstrue Engstrom’s holding. A subrogating party may assert several strong arguments in response, ranging from clarification of the Engstrom decision and progeny to an explanation of the Medicare structure and the applicable regulations. This article provides a brief background of Medicare and the Medicare Secondary Payer rules, as well as addresses the typical issues that arise regarding the Engstrom decision. Read more