Proposal to Make Medicare Set-Aside Approval by CMS Optional

While proposed amendments to Maryland workers compensation regulations represent an improvement from the emergency rule adopted Jan. 4, 2010, the Property Casualty Insurers Association of America (PCI) reports it still has concerns regarding their impact.

 

 

The regulation, COMAR 14.09.01.19, would establish guidelines for reviewing and approving proposed workers comp settlement agreements in compliance with the review thresholds established by the federal Centers for Medicare and Medicaid Services (CMS) and spell out the data elements that must be part of all settlement agreements. (WCxKit)

 

 

According to PCI, the regulations will make settlement of Maryland workers comp claims more cumbersome and force injured or disabled workers to hire expensive legal assistance to navigate the complex language of those claims. That could mean higher costs not just for individuals, but also the state.

 

 

“There are administrative fees and expenses associated with the administration of a Workers Compensation Medicare Set-Aside Arrangement (WCMSA) and potentially extra attorney fees for setting up a WCMSA,” said Richard Stokes, PCIs Maryland counsel. “This can add thousands of dollars to the cost of settling a Maryland workers compensation claim. In addition, the requirement that all formal set-aside allocations comply with Medicare guidelines adds extraordinary complexity to settlement submission and approval. This adds to the costs of carriers to handle workers compensation claims in Maryland and adds to the administrative costs of the Maryland Workers Compensation Commission to review and approve settlements.”

 

 

Additionally, the added complexity could mean that workers could have to wait 3-6 months for CMS approval of a settlement, creating an additional and unnecessary hardship. PCI proposes changing the regulation to make it optional, but not mandatory, for settlements to be submitted to CMS for approval. (WCxKit)

 

 

“Injured or disabled workers in need should not have to face months of additional waiting for settlements that more bureaucratic red tape could cause,” Stokes added. “We recommend that this regulation be amended. We appreciate the opportunity to submit comments and be heard on this important issue.”