Among the many efforts to streamline and improve Medicaid, there has not been considerable focus over the past five years to improve the states’ Medicaid “third party liability” programs. Fortunately, Congress has the chance to correct that now by enacting the Medicaid TPL provisions of the Healthy Kids Act (H.R. 3921) that was recently approved by the House Energy & Commerce Committee.
It is hard to imagine that in 2003, when Congress enacted the Medicare Modernization Act (MMA) and created the Medicare Prescription Drug Program (the “Part D” program), nobody really knew whether beneficiaries would actually sign up. Nor did Congress know whether, or how, the law would actually work.
The CMS administrator at the time, Tom Scully, famously noted that a prescription drug program “does not exist in nature.” In fact, at the time no model existed for a federally subsidized private insurance program, and there was nothing the Congress could use as a template. At best, Congress looked to the Medicare Advantage program as a guide for several of the operational aspects of the new Part D program. But even that was a poor analog.
MARC COALITION APPLAUDS REPS. MURPHY, KIND ON BIPARTISAN BILL TO IMPROVE MEDICARE SECONDARY PAYER POLICY
The Medicare Advocacy Recovery Coalition (MARC) today lauded Rep. Tim Murphy (R-PA) and Ron Kind (D-WI) for their introduction of the Secondary Payer Advancement, Rationalization, and Clarification (SPARC) Act (H.R. 1122) – a bipartisan measure to improve the Medicare Secondary Payer (MSP) program in Medicare Part D. While the MSP policy is designed to ensure that the Medicare program and prescription drug plans (PDPs) do not reimburse healthcare expenses for which another entity is legally responsible, literally every stakeholder agrees that the process by which PDPs recapture payment for claims that were not its responsibility to pay is broken. The SPARC Act will significantly improve the efficiency of the current system, providing a clear framework for communication among all stakeholders involved.
Medicare Advantage Plans (MAPs), also known as Medicare “Part C,” are private insurance plans that provide a Medicare beneficiary’s “Part A” and “Part B” benefits. A Medicare beneficiary can choose to enroll in a MAP rather than traditional Medicare. Part D plans provide benefits for a Medicare beneficiary’s prescription drugs. It is important to note that traditional Medicare generally does not provide prescription coverage directly; a beneficiary must enroll in a Part D plan to receive Part D benefits.
Over the past year, I've been able to learn a lot about the Medicare Advocacy Recovery Coalition (MARC), an organization consisting of representatives from all over the workers' comp industry - carriers, TPAs, comp service providers, attorneys, employers, and more.
Greg McKenna, Vice President and Counsel for Gallagher Bassett Services, invited me to attend a MARC meeting at the WCI Conference in Florida last year. To say I was impressed would be an understatement. This group of men and women - who on most days are competing against each other for business - come together on a regular basis to advocate for the improvement of MSP programs - something that affects us all.
MARC Coalition Applauds Bipartisan Senate Letter to CMS Urging Prompt Implementation of the Strengthening Medicare and Repaying Taxpayers (SMART) Act
WASHINGTON, July 17, 2014 /PRNewswire-USNewswire/ -- The Medicare Advocacy Recovery Coalition (MARC) applauds the United States Senate for its bi-partisan letter to the Center for Medicare and Medicaid Services (CMS), urging the Agency to implement promptly the Strengthening Medicare and Repaying Taxpayers (SMART) Act, signed into law on January 10, 2013. Under the legislation, CMS by October 2013 was to have implemented an electronic “portal” for the exchange of final conditional payment information, and was by July 10, 2014 to have eliminated the use of full Social Security numbers in the MSP Reporting process. Seven Senators, led by Senator Rob Portman (R-OH), urged the Agency to promptly and swiftly implement the changes required by the law.
The U.S. Centers for Medicare and Medicaid Services will officially merge the Coordination of Benefits and Medicare Secondary Payer Recovery teams into a single unit, which should save workers' compensation attorneys several phone calls a year on conditional payment issues.
The Centers for Medicare and Medicaid Services on Thursday announced plans to seek comments on proposed rules to implement the first appeals process for insurers and self-insured employers targeted for recovery actions in workers' compensation, liability and no-fault settlements to meet the requirements of the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012.
The Centers for Medicare and Medicaid Studies is seeking proposals on how it should penalize insurers who violate the agency's claim-reporting requirements, and payers are responding that the agency should not penalize insurers who are making a good-faith effort to send the agency their data.