Does CMS provide an example of an acceptable format for a Medicare Set-aside or CMS referral?
A34. Yes. A sample Medicare Set-aside mechanism and proposal may be found at http://www.cms.hhs.gov/WorkersCompAgencyServices/Downloads/samplesubmission.pdf Q35. In a workers’ compensation settlement, is a Medicare Set-aside recommended where the injured party is covered under a group health plan, managed care plan, or has coverage through the Veterans Administration? A35. Yes, a Medicare Set-aside is still appropriate because such other health insurance or health service could in the future be canceled or reduced, or the injured party may elect not to take advantage of such medical services or prescription drug coverage. It is important to remember that workers’ compensation, liability or group health coverage is always primary to Medicare for expenses related to the workers’ compensation or liability settlement. If the injured party belongs to a HMO that may not be coordinating benefits based on workers’ compensation entitlement, the settlement should still set-aside funds for Medica
Related Questions
- Are there documentation requirements that must be satisfied before CMS can provide a written opinion on the sufficiency of a Medicare Set-aside?
- Does CMS provide an example of an acceptable format for a Medicare Set-aside or CMS referral?
- What is the referral process for submission of a proposed Medicare Set-aside to CMS?
