Does Medicare give written advance advisory opinions on the sufficiency of a Medicare Set-aside even if the injured party is not as yet entitled to Medicare?
A20. Yes. CMS established case review thresholds (currently only with workers’ compensation settlements, Q39) and will review a proposed settlement including a Medicare Set-aside and give a written opinion on which the injured party and the attorney can rely, regarding whether the settlement has adequately considered Medicare’s interests pursuant to ’42 CFR 411.46. These proposed settlements are handled on a case-by-case basis, as each situation is different. Comment: Certain CMS Regional Offices are reviewing liability Medicare Set-aside proposals (LMSA). Until such time as CMS promulgates review thresholds for liability cases the referral of a proposed liability settlement to CMS would suggest an unnecessary exercise given CMS’ absence of any due process appeal rights to their analysis.
Related Questions
- Does Medicare give written advisory opinions on the sufficiency of a Medicare Set-aside even if the injured party is not as yet entitled to Medicare?
- Are there documentation requirements that must be satisfied before CMS can provide a written opinion on the sufficiency of a Medicare Set-aside?
- Is the injured party entitled to a release of the Medicare Set-aside funds if the injured party loses Medicare entitlement?
