Does the injured party have to resubmit the Medicare Set-aside proposal after January 1, 2006 if CMS has already issued a written opinion as to the total Medicare Set-aside amount?
A75. No. A previously submitted Medicare Set-aside proposal does not have to be resubmitted (a) if CMS has already issued a written opinion as to the total Medicare Set-aside amount for settlements occurring prior to January 1, 2006, or (b) where the Medicare Set-aside proposal was reviewed prior to January 1, 2006. Note, if the workers’ compensation settlement occurred prior to January 1, 2006, and the workers’ compensation settlement included an allocation for future prescription drug treatment, then the injured party must exhaust those funds before Medicare can be billed for those future prescription drugs. However, the injured party does not have to transfer these funds to the existing Medicare Set-aside account or include them in the annual Medicare Set-aside accounting.
A76. No. A previously submitted Medicare Set-aside proposal does not have to be resubmitted (a) if CMS has already issued a written opinion as to the total Medicare Set-aside amount for settlements occurring prior to January 1, 2006, or (b) where the Medicare Set-aside proposal was reviewed prior to January 1, 2006. Note, if the workers= compensation settlement occurred prior to January 1, 2006, and the workers= compensation settlement included an allocation for future prescription drug treatment, then the injured party must exhaust those funds before Medicare can be billed for those future prescription drugs. However, the injured party does not have to transfer these funds to the existing Medicare Set-aside account or include them in the annual Medicare Set-aside accounting.
Related Questions
- Does the injured party have to resubmit the Medicare Set-aside proposal after January 1, 2006 if CMS has already issued a written opinion as to the total Medicare Set-aside amount?
- If the injured party or his/her representative disagrees with the amount that CMS has determined for the Medicare Set-aside is there any appeal process?
- What happens if the Medicare Set-aside proposal received after January 1, 2006 does not include an amount for future prescription drug treatment?
