LexisNexis® Legal Newsroom
What You Need to Do Now About the Medicare Set-Asides in Your Files - Effect Of The Affordable Health Care For America Act On Part D MSA Allocations

The new health care reform law includes closure of the Part D prescription coverage gap known as the donut hole. The law gradually reduces the donut hole until it disappears in 2020. Since prescription coverage was added to Medicare under the George W. Bush administration, there have been 4 tiers...

CMS’ Memorandum Regarding Rated Age Attestation/Certification and Medications Prescribed for Off-Label Uses

ISSUES PRESENTED Issue 1: “Rated Age Attestation” Requirement Upgraded to “Certification Statement” Effective Immediately Despite CMS Processing Backlog CMS has rescinded the prior 08/25/08 policy requiring submitters to attest to the fact that all rated ages obtained on...

Maryland Workers' Compensation Commission Holds Public Hearing on Emergency Regs for Medicare Set-Asides

The Maryland Workers’ Compensation Commission held a public hearing today on the emergency regulations for Medicare Set-Asides. The proposed changes would amend COMAR 14.09.01.19 Agreements for Final Compromise and Settlement. At today’s hearing, it appeared that the Commission plans to...

Attorneys Fees and WCMSA - How to Stir Up a Hornet’s Nest in California

This article will make you squirm. Here is a vexing question – can an applicant’s attorney claim part of his or her attorneys fees off of workers’ compensation Medicare set-aside (WCMSA) proceeds when a workers’ compensation case is settled via a compromise and release? For example...

2010 Year in Review: The Top 10 Workers’ Compensation Issues From a National Perspective

As I gaze back over this rapidly closing year and try to describe the dominant issues that have engaged those of us within the workers' compensation arena, I am mindful of the story of the three blind men who were asked to describe an elephant. Their eyes useless to them, they all awkwardly gathered...

Medicare Set-Asides and Special Needs Trusts

By Jennifer C. Jordan, Esq., General Counsel, MEDVAL LLC Now that those involved in personal injury settlements, whether workers’ compensation or liability insurance based, have finally come to understand the Medicare Secondary Payer Act (“MSP”) to some extent, it appears that...

Off-Label Drugs and Workers’ Compensation Medicare Set-Asides

By Jennifer C. Jordan, Esq., General Counsel, MEDVAL, LLC With the addition of Part D to the Medicare program in 2006, Medicare set-aside allocations (“MSAs”) grew exponentially overnight. The problem was further exacerbated by the April 9, 2009 CMS memo mandating that the preferred method...

How California Handles the WCMSA Process

There is a garden industry that has emerged since 1997 in California of companies who have become “WCMSA specialists”, promoting themselves as experts in developing WCMSA proposals that will pass muster with CMS. Most workers’ compensation legal practitioners who represent injured workers...

How California Handles the WCMSA Process

There is a garden industry that has emerged since 1997 in California of companies who have become “WCMSA specialists”, promoting themselves as experts in developing WCMSA proposals that will pass muster with CMS. Most workers’ compensation legal practitioners who represent injured workers...

Determining Medicare Status - Assessing CMS’ Query Process System in the Bigger Picture of MSP Compliance

By Mark Popolizio, Esquire, Section 111 Senior Legal Counsel, Crowe Paradis Services Corporation Determining a claimant’s Medicare status is an integral part in evaluating one’s compliance obligations under the Medicare Secondary Payer Statute (MSP). When a claimant is identified as a...

Determining Medicare Status - Assessing CMS’ Query Process System in the Bigger Picture of MSP Compliance

By Mark Popolizio, Esquire, Section 111 Senior Legal Counsel, Crowe Paradis Services Corporation Determining a claimant’s Medicare status is an integral part in evaluating one’s compliance obligations under the Medicare Secondary Payer Statute (MSP). When a claimant is identified as a Medicare...

Thomas A. Robinson on 2011 Year in Review: Top 10 Issues in Workers’ Compensation Law

In this LexisNexis Emerging Issues Analysis article, Thomas A. Robinson analyzes the top 10 workers’ compensation events for 2011, with an eye to the hot button issues for 2012. > You can purchase the article at the LexisNexis Bookstore . > Lexis.com subscribers can access the complete...

Four Reasons to Avoid the CMS Approval Process for MSAs

By Teddy Snyder, Esq., Ringler Associates - Beverly Hills, CA 1. MMSEA reporting makes approval unnecessary for Medicare beneficiaries. Reporting under the Medicare, Medicaid and S-Chip Extension Act, aka “section 111 reporting”, started January 1, 2010 for workers compensation claims...

Four Reasons to Avoid the CMS Approval Process for MSAs

By Teddy Snyder, Esq., Ringler Associates - Beverly Hills, CA 1. MMSEA reporting makes approval unnecessary for Medicare beneficiaries. Reporting under the Medicare, Medicaid and S-Chip Extension Act, aka “section 111 reporting”, started January 1, 2010 for workers compensation claims...

WCRI’s Baseline for Evaluating Impact of North Carolina’s 2011 Workers’ Comp Reforms: A Measuring Stick That Falls Short

By Vernon Sumwalt WCRI’s “ Baseline for Evaluating Impact of 2011 Reforms in North Carolina: CompScope™ Benchmarks, 12th Edition ” (the “WCRI study”) tries to provide a measuring stick to evaluate the 2011 amendments to the North Carolina Workers’ Compensation...

Illinois Court Permits Ex-Wife to Take a Percentage of MSA Account as Part of Divorce Action

By: Mark Popolizio, Esquire, Crowe Paradis Services Corporation In the case of In re Marriage of Washkowiak , 2012 Ill. App. Lexis 151 (Ill. App. 3 Dist., March 7, 2012) the Illinois Appellate Court ruled that a claimant’s former wife was entitled to receive 17.5% of the funds from his Medicare...

No Boundaries – RIMS 2012 Annual Conference & Exhibition

By Jennifer C. Jordan, Esq. The annual conference held by the Risk and Insurance Management Society is being held April 15 through April 18 at the Philadelphia Convention Center and, as always, is anticipated to be the biggest gathering of insurance professionals all year. With more than 120 sessions...

Love It or Hate It: Medicare Secondary Payer Enforcement Is Here to Stay

By Jennifer C. Jordan, Esq. Progress is the theme of this year’s update to The Complete Guide to Medicare Secondary Payer Compliance , 2012 Edition (available in October; see special offer below). Nothing has improved so much that people don’t still cringe at the mention of MSAs, but after...

California WCMSA: Separate Settlements for Each Claim - The Benson Case

By Robert G. Rassp, Esq. Appellate review of California Labor Code Sections 4663 and 4664 on apportionment has mandated that physicians provide in their conclusions with reasonable medical probability approximately what percentage of permanent disability or impairment is directly caused by each industrial...

California WCMSA: Separate Settlements for Each Claim - The Benson Case

By Robert G. Rassp, Esq. Appellate review of California Labor Code Sections 4663 and 4664 on apportionment has mandated that physicians provide in their conclusions with reasonable medical probability approximately what percentage of permanent disability or impairment is directly caused by each industrial...

NCCI Research Brief on Medicare Set-Asides and Workers' Compensation

NCCI has recently examined the demographics related to MSAs (distributions of amounts of MSAs and total settlements that include MSAs; distributions of ages of claimants) and the aspects of the CMS review process (length of time from submission to CMS approval; relation between submitted and CMS-approved...

Fifteen Years Since the Patel Memo and Medical Secondary Payer Issues Continue to Mystify

Every year we take the time to update The Complete Guide to Medicare Secondary Payer Compliance and it always forces me to reflect on how much Medicare Secondary Payer (MSP) compliance has changed over the years, yet so much stays the same. Yes, we find new issues from time to time, but fundamentally...