Managing "Medicare risk" is a growing concern for carriers, TPAs, and self insured self administered employer groups. Adequate consideration must be given to Medicare when closing or limiting future medical as part of a settlement. When managing your Medicare risk for "qualified claimants," parties must secure Medicare Set-Asides (MSAs). In order to manage the Medicare risks, respective parties should comply with the requirements derived by the Medicare Secondary Payer Statute (MSP) & the State Child Health Insurance Program (SCHIP), Section 111. The United States Code, Title 42, Chapter 7, Subchapter XVIII, Section 1395Y comprises the Medicare Secondary Payer Statute (MSP). The law requires that "adequate consideration" of Medicare's interests be made in all Workers' Compensation settlements that seek to limit or close future medicals. Medicare's administrative guidelines require that settlements with "qualified claimants" be reviewed and approved by Medicare in order to create a compliant settlement. A Medicare Set-Aside is a projection of the future Medicare covered medical expenses associated with the workers' compensation claim. The MSA allocation can be self administered or professionally administered by a custodial fund administrator. Annual reporting is required to CMS (Center For Medicare and Medicaid Services). Employers should work closely with a national/regional structured settlement firm, and fund the MSAs with annuities – as this will position them to control their loss dollar spent on MSA allocations. Using annuities to settle claims means saving on each MSA. Partnering with a leading firm allows you to manage your Medicare Risk as a "program." If you are working with a particular firm, include that in your account instructions.
If you need more information about Medicare Set-Asides, you can contact www.gouldandlamb.com. Thanks Gould and Lamb for providing this important information.