What happens if CMS closes its case because the Medicare Set-aside submitter failed to provide requested information in a timely manner?
A72. If the workers’ compensation case did not “settle” prior to January 1, 2006, and the submitter provides additional documentation with regard to the closed case on or after January 1, 2006, the case is considered a new Medicare Set-aside submission and the requirements related to: (1) future medical treatment; and, (2) future prescription drug treatment will be applied to the new Medicare Set-aside submission. If, however, the workers’ compensation claim settled prior to January 1, 2006 and the submitter provides additional documentation with regard to a closed case, the case is considered a new Medicare Set-aside submission; however, the Medicare Set-aside proposal does not need to include an amount for future prescription drug treatment.
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?
- What happens if CMS closes its case because the Medicare Set-aside submitter failed to provide requested information in a timely manner?
- Does CMS propose that a Medicare Set-aside be established in situations that involve both a workers compensation and a liability claim?
