CMS APPROVAL?

As a refresher to our July 2011 newsletter, there is no statutory or regulatory authority requiring CMS approval of a workers’ compensation Medicare set‑aside arrangement (WCMSA).  A series of CMS policy memos clearly implied a “requirement” over the past several years, but in May 2011 CMS issued another policy memo which confirmed: There are no

New CMS Memorandum Addresses Liability Medicare Set Aside Arrangements

On September 29, 2011, the Centers for Medicare & Medicaid Services issued its newest memorandum.  The memorandum, a copy of which follows this Alert, provides insight into the issue of when a Liability Medicare-Set Aside proposal should be submitted to CMS.  While CMS has provided fairly clear work-level review thresholds in the workers’ compensation arena,

Appellate Court Upholds Sanctity of Section 5b

Loryann Johnson vs. Ayalnesh A. Tikuye and Amigo Driving School No. No. 1-10-0114 Loryann Johnson was employed by the Secretary of State as a license examiner.  She was injured while working, administering a driving test to Ayalnesh Tikuye. She collected workers’ compensationbenefits for her injuries, which included medical payments, lost wages and a lump sum

Commission Has Jurisdiction to Adjudicate Fraud in Pending Cases

Country Insurance & Financial Services vs. Timothy B. Roberts No. No. 1-10-3402 The Appellate Court, First District, has weighed in on the subject of fraud in workers’ compensation cases, this time in a case pending before the Commission.  Roberts filed an application alleging work-related injuries on January 16, 2007, following which Country Insurance paid temporary

Congress and the MSP

In last month’s Newsletter, we shared information on Congressional attention being paid to the MSP. On July 25, 2011, members of the Subcommittee on Oversight and Investigations sent a letter to the Secretary of Health and Human Services and the Center for Medicare and Medicaid Services Administrator outlining its position on the current state of

New WCMSA Review Contractor

CMS has awarded the contract to review Workers’ Compensation Medicare Set-Aside submissions to a new vendor (Provider Resources, Inc.).  The new contract runs through June 30, 2012.  CMS mandated that the new contractor achieve significant decreases in the time it takes to complete the WCMSA submission process.  CMS’ Request for Proposal (RFP) included provisions that

Web Based Submission Portal

As the Workers’ Compensation Medicare Set-Aside (WCMSA) submission process is currently implemented, CMS only accepts WCMSA proposals via regular mail.  All necessary materials must be scanned into PDF format, put onto a compact disc, and mailed to the Workers’ Compensation Review Contractor.  Once the contractor receives the WCMSA proposal, it must upload the information into

Congress and Medicare

In June, 2011, congressional hearings were held in Washington D.C. to examine systems under the Medicare Secondary Payer Law.  Objectives included whether the systems adequately protect the interests of Medicare beneficiaries, businesses, taxpayers, and other interested parties. Particular focus has been on the conditional payment aspect of the MSP. The MARC Coalition’s H.R. 1063; “Strengthening

CMS Policy for Set-Aside Submission

As covered in previous Wiedner & McAuliffe Newsletters, CMS issued a Memorandum on May 11, 2011.  This was intended by CMS to “reiterate guidance provided in [prior procedure] Memoranda regarding CMS’ Workers’ Compensation Medicare Set‑Aside Agreement (WCMSA) proposal review threshold …” The Memorandum was a response, in part, to legislative efforts in some states to make

Record Review Reports Subject to Section 12

William Mulligan v. Illinois Workers’ Compensation Commission No. 1-09-2507WC William Mulligan suffered injuries on separate dates to his right knee and cervical spine which he claimed rendered him totally disabled from working.  His employer disputed this claim based on Mulligan’s long history of multiple knee surgeries, including a total knee replacement, and prior surgery to