What authority gives CMS the right to seek a Medicare Set-aside?
Comment: These statutes and regulations do not constitute “legal authority” to mandate use of a Medicare Set-aside or the prior approval of a Medicare Set-aside. What they do reinforce is that Medicare is secondary to any available primary payer policy, whether that policy is a workers’ compensation, liability or group health policy and that if Medicare does make a conditional payment(s) Medicare has an absolute right to seek recovery. It is also true that the regulations, as currently written, only apply to workers’ compensation and not liability. That being said the existence of regulations and statues since 1980 clearly provide that Medicare is a secondary payer to workers’ compensation, liability and group health policies and clearly provides Medicare the authority to deny payment when there is other valid and collectable coverage. A3. Section 1862(b)(2) of the Social Security Act and ’42 USC 1395y(b)(2 )requires that Medicare payments may not be made for any item or service to the
Comment: These statutes and regulations do not constitute Alegal authority@ to mandate use of a Medicare Set-aside or the prior approval of a Medicare Set-aside. What they do reinforce is that Medicare is secondary to any available primary payer policy, whether that policy is a workers’ compensation, liability or group health policy and that if Medicare does make a conditional payment(s) Medicare has an absolute right to seek recovery. It is also true that the regulations, as currently written, only apply to workers’ compensation settlements and not to liability settlements. That being said the existence of regulations and statues since 1980 clearly provide that Medicare is a secondary payer to workers’ compensation, liability and group health policies and clearly provides Medicare the authority to deny payment when there is other valid and collectable coverage. A3. Section 1862(b)(2) of the Social Security Act and 42 USC 1395y(b)(2 ) requires that Medicare payments not be made for any
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 propose that a Medicare Set-aside be established in situations that involve both a workers compensation and a liability claim?
- What authority gives CMS the right to seek a Medicare Set-aside?
