On March 9, 2010, Representative Patrick Murphy (D-PA) introduced H.R. 4796, the Medicare Secondary Payer Enhancement Act of 2010, into the U.S. House of Representatives. H.R. 4796 is currently in the early stages of the legislative process, having last been referred to the House Energy and Commerce Committee on March 9, 2010.
H.R. 4796 proposes several changes to the Medicare Secondary Payer Act (MSP Act) (42 U.S.C. § 1395y(b)) and reporting under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007, Pub. L. 110-173 (42 U.S.C. 1395y(b)(7) & (8)).
The proposed changes to the MSP Act include the following:
A claimant and applicable plan would be able to voluntarily submit a proposal of conditional payment calculations to the Centers for Medicare and Medicaid Services (CMS) at least 90 days prior to settlement, judgment, award or other payment that estimates the amount of medical care payable by Medicare related to the injury/claim, computing reimbursement based on available billing data. CMS is empowered to review and contest the submission, but if CMS does not do so within 90 days, the amount is deemed to be the MSP payment amount for all conditional payments related to the claim.
A claimant and applicable plan would have the option of requesting a final demand letter from CMS for conditional payments within 120 days of settlement, judgment, award or other payment. CMS has 60 days to respond to such a request, and if the claimant or applicable plan reimburses CMS within 60 days of the response, the reimbursement is deemed to satisfy obligations of the claimant and applicable plan for conditional payments.
Claimants and Non-Group Health Plan applicable plans (which include liability, self-insurance, workers’ compensation and no-fault insurance) could appeal the MSP determination in a manner similar to that already made available to Group Health Plans.
- The act would set a minimum threshold for MSP recovery actions at settlements, judgments, awards or other payments valued at $5,000. Payments under this threshold are exempt from MSP.
- The act would impose a $30 user fee for each expedited voluntary payment or request for a final demand of conditional payment.
The proposed changes to Section 111 reporting include the following:
Require CMS to implement a Section 111 reporting process that excludes the reporting of health insurance claim numbers and Social Security numbers
Set a statute of limitations on MSP recovery actions at three years following submission of the Section 111 report
- Modify the current Section 111 penalty provisions to provide the government with discretion to impose penalties, and require the U.S. Department of Health and Human Services to develop safe harbors for meeting reporting requirements