Synergy Blog

AAJ Announces that Regulations Regarding Medicare Set Asides are Coming

From the AAJ’s CEO:

Dear AAJ Members,

As you may have heard, the Centers for Medicare & Medicaid Services (CMS) will likely be moving forward with the process of developing new regulations that will address payment of future medical costs in liability cases. At this point, we anticipate that CMS will issue a Notice on Proposed Rulemaking sometime before the end of the year. Currently CMS has guidance in place on how to treat future medical expenses in workers’ compensation cases. There has never been similar guidance or regulations regarding liability cases.

In June, 2012, CMS issued an Advanced Notice on Proposed Rulemaking (ANPRM) that proposed regulations to govern how and when an injured individual who receives a judgment, settlement, or award would need to pay for any future medical care needed as a result of the accident, illness, or injury in question. AAJ filed lengthy comments in opposition to the ANPRM stating that:

“requiring payment for future medical care from liability settlements is far too attenuated, has an inequitable impact on Medicare beneficiaries, in particular severely sick or injured beneficiaries, and also has a chilling effect on the ability of parties to bring and settle liability claims.”

AAJ remains in opposition to rules governing payment for future medical care in liability cases. As the process continues, and in order to achieve the best advocacy for members of the American Association for Justice, we will establish an advisory committee that will provide substantive input into the new CMS proposal. AAJ Vice President Larry Tawwater has volunteered to lead this committee.

When CMS issues this expected Notice on Proposed Rulemaking, there will be a comment period during which interested stakeholders can comment on the substance of the proposed rule. CMS then must review those comments before any rule can be finalized and become effective.

If you have questions concerning this issue please email public_affairs@justice.org.

We will continue our strong advocacy in this arena. We know it is of utmost importance to you and your clients.

Best Regards,

 

Linda A. Lipsen
CEO
American Association for Justice

TESTIMONIALS

“Synergy Lien Resolution Services just finished getting an ERISA lien dramatically reduced for me. I tried for months, asked for the plan etc., tried to understand it, to little avail. Synergy got it slashed way beyond what the carrier told me that they would ever agree to. It cost my client peanuts, benefited her huge. I won’t ever screw around with trying to get those reduced; from now on they all go to Synergy.”

Rick Kolodinsky
Rick Kolodinsky, P.A.

"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

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