What is CMS policy regarding the inclusion of prescription drugs in a Medicare Set-aside with the implementation of the Medicare Modernization Act of 2003 (MMA)?
A66. All Medicare Set-asides involving workers’ compensation settlements that occur on or after January 1, 2006 must include separate pricing for prescription drugs and medical services. If the workers’ compensation claim was settled prior to January 1, 2006, the Medicare Set-aside proposal did not need to specify a separate amount for future prescription drug treatment but rather allowed for prescription drug and medical services to be lumped together. CMS’s policy regarding the pricing of prescription drugs did not change with the passage of this Act. However, as of June 1, 2009 CMS now requires that prescription drugs be priced using the average wholesale price as listed in Redbook. The Medicare Set-aside must now include separate amounts for (a) future medical treatment, and (b) future prescription drug treatment. In addition, the Medicare Set-aside must include an a payment history of the prescription drugs paid by the workers’ compensation carrier, as follows:1. If the injury occ
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- What is CMS= policy regarding the inclusion of prescription drugs in a Medicare Set-aside with the implementation of the Medicare Modernization Act of 2003 (MMA)?
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- Why does the policy put several restrictions on sub-delegation when the Public Service Modernization Act encourages delegation to the lowest possible level?
