WASHINGTON, DC – The Medicare Advocacy Recovery Coalition (MARC) today applauded the introduction of the Provide Accurate Information Directly Act (PAID Act) (H.R. 1375), a bipartisan bill to improve the Medicare Secondary Payer process and provide a clear framework for communication among involved stakeholders.
 
​​"The PAID Act will ensure that there is a clear and functional system for sharing information between settling parties and Medicare stakeholders,” said Re Knack, Chair of MARC, DRI Member and Chair Emeritus for DRI’s MSP Task Force. “We thank Representatives Ron Kind (D-WI) and Gus Bilirakis (R-FL) for their leadership in helping ensure claims can be resolved promptly and beneficiaries can receive what they are owed.”
 
The Medicare Secondary Payer (MSP) policy was designed to ensure that the Medicare and Medicaid programs do not pay for healthcare expenses for which another party is responsible. However, the process by which the Centers for Medicare and Medicaid Services (CMS) recuperates payments from settling parties for claims related to Medicare Advantage, Part D, or Medicaid plans is currently broken. Settling parties have no way to find out if a beneficiary is even enrolled in a MA or Part D plan much less which plan a beneficiary may be enrolled in.  Without this information, parties will not even know they have an obligation to reimburse the plan, or what plan they must reimburse.  This results in situations where a party may close a claim only to find out a year or more later that they have a reimbursement obligation.
 
For beneficiaries seeking care for conditions unrelated to the original settlement, this could result in care delays, as both the settling party and CMS try to reconcile their respective records.

The PAID Act offers a commons sense solution to this issue by requiring CMS to disclose to the settling party which plan a beneficiary is enrolled in through the Section 111 query process, a system that already exists to share information between Medicare and third parties.
 
“We urge Congress to pass this bipartisan legislation, achieve a more efficient solution for beneficiaries, taxpayers, and employers,” Knack concluded.

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About MARC
When a beneficiary is injured, and another party is supposed to cover their healthcare expenses – such as in a worker’s compensation claim – Medicare’s legal responsibility to pay is “secondary.” Unfortunately, the current Medicare Secondary Payer (MSP) policy is convoluted and confusing, creating problems and inefficiencies for beneficiaries, settling parties and taxpayers alike. That’s why MARC exists: to support commonsense reforms to fix this broken system. MARC's membership represents virtually every sector of the MSP regulated community including attorneys, brokers, insureds, insurers, trade associations, self-insureds and third-party administrators. For more information on MARC, please visit www.MARCcoalition.com.

In an article for CLM Magazine, MARC Coalition's Heather Sanderson urges primary plans to consider best practices as courts rule in favor of Medicare Advantage Plans (MAP) recovering double damages. Sanderson astutely notes that with both the 3rd and 11th Circuit Courts finding in favor of MAPs being allowed to bring an Medicare Secondary Payer (MSP) private cause of action for double damages, industry is seeing "widespread" application of the double damages across the country. "The ease with which courts have determined a MAP can allege a sufficient double-damages MSP private cause of action claim is alarming," writes Sanderson. "A recent district court case out of Illinois found that, for a MAP to allege an MSP private cause of action, it simply needs to allege that there is no genuine issue of material fact regarding the defendant’s status as a primary plan, the defendant’s failure to provide for primary payment or appropriate reimbursement, and the damages amount."

​In health policy, the minutia is not trivial; it’s essential. Small incentives created by policymakers can have a significant impact upon how Medicare beneficiaries, doctors, hospitals and insurers respond to health care claims. But sometimes policies — even the most well-intentioned — can have unintended consequences, leading to wasted resources, burdensome regulations and broken promises to the very people that the system is designed to serve.

MARC's Heather Sanderson and David Farber penned an article in CLM Magazine outlining issues within Medicaid Third Party Liability (TPL)  programs that can be solved by implementing the Provide Accurate Information Directly (PAID) Act. "The good news is that congress has the opportunity to get Medicaid TPL right. First, Congress should focus the data and follow the money by working to streamline TPL recoveries from Medicare and group health policies. Second, Congress should enact the PAID Act -- recently introduced legislation that would require CMS to respond to a 'Section 111 query' with enrollment information about the beneficiary's Medicare Advantage, Part D, and Medicaid status." 

MEDVAL reports on the introduction of the PAID Act and its potential to improve Medicare Secondary Payer program. "H.R. 5881 proposes that CMS share information regarding enrollment in MAP, Part D, and Medicaid to assist with the timely discovery of conditional payments and liens.  As we have seen and written about here on our blog, we are consistently seeing MSP litigation and aggressive recovery efforts throughout the country.  The timely sharing of information and ultimate identification of a beneficiary’s enrollment in supplemental plans would certainly decrease the amount of litigious MSP recovery efforts, as well as the concerns of double damages."

FOR IMMEDIATE RELEASE
Contact:  Andrew Rosenberg (arosenberg@thornrun.com), (202) 247-6301

The Medicare Advocacy Recovery Coalition (MARC) today lauded Rep. Gus Bilirakis (R-FL) and Ron Kind (D-WI) for their introduction of the Provide Accurate Information Directly Act (PAID Act) (H.R. 5881) – a bipartisan measure to improve the Medicare Secondary Payer (MSP) and Medicaid Third Party Liability (TPL) statute. While the MSP policy is designed to ensure that the Medicare and Medicaid programs do not reimburse healthcare expenses for which another entity is legally responsible, every stakeholder agrees that the process by which improper payments are recaptured is broken. The PAID Act will significantly improve the efficiency of the current system, providing a clear framework for communication among all stakeholders involved.   MARC applauds Congressmen Bilirakis and Kind for their leadership in solving this important problem.

FOR IMMEDIATE RELEASE
Contact:  Andrew Rosenberg (arosenberg@thornrun.com), (202) 247-6301

​The Medicare Advocacy Recovery Coalition (MARC), a national coalition of stakeholders advocating for the improvement of the Medicare and Medicaid Secondary Payer (MSP) programs, applauded the Congress for enacting Section 53102 of the Bipartisan Budget Act of 2018 to repeal Medicaid third party liability (TPL) policies that have the effect of eliminating the incentive for beneficiaries to pursue and settle third-party insurance claims. MARC has consistently advocated for these reforms, which would support Medicaid beneficiaries and the Medicaid program at-large by removing barriers to beneficiaries reaching a settlement when another party is liable for their health care expenses — such as a car accident or a workers’ compensation claim. 

FOR IMMEDIATE RELEASE
Contact:  Andrew Rosenberg (arosenberg@thornrun.com), (202) 247-6301

The Medicare Advocacy Recovery Coalition (MARC), a national coalition of stakeholders advocating for the improvement of the Medicare and Medicaid Secondary Payer (MSP) programs, applauded the House of Representatives’ inclusion of language in the continuing resolution (CR) to repeal Medicaid third party liability (TPL) policies that have the effect of eliminating the incentive for beneficiaries to pursue and settle third-party insurance claims. MARC has consistently advocated for these reforms, which would support Medicaid beneficiaries and the program at-large by removing barriers to reaching a settlement when another party is liable for their health care expenses — such as a car accident or a workers’ compensation claim. ​

FOR IMMEDIATE RELEASE
Contact:  Andrew Rosenberg (arosenberg@thornrun.com), (202) 247-6301
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The Centers for Medicare and Medicaid Services (CMS) should take immediate steps to curtail the practice of recommending lifetime use of addictive pain medications for individuals who set up Workers’ Compensation Medicare Set-Aside Arrangements (MSAs), according to a recent letter from the Medicare Advocacy Recovery Coalition (MARC). 
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Today, Medicare Advocacy Recovery Coalition (MARC) Chairman Greg McKenna submitted a comment letter to CMS Administrator Seema Verma in response to the proposed rule entitled ​"Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program." In the letter, Chairman McKenna applauded CMS' ​initiatives to address the nation's opioid epidemic, and stressed that CMS must to ensure that frequently abused drugs are appropriately managed so that Medicare beneficiaries at risk of abuse and addiction cannot access them through the Part D program. "We write today to urge CMS in both its final rule and in the final rule preamble to address how frequently abused drugs could be accessed through Workers Compensation Medicare Set Aside arrangements (MSAs)," wrote Chairman McKenna.