The Medicare Advocacy Recovery Coalition (MARC) thanks the Congress for passing the PAID Act (H.R. 1375, Section 1301 of H.R. 8900) on December 11, 2020.  The bill was brought to the House Floor and passed by voice vote on December 8, 2020.  Following House approval, the PAID Act was included as Section 1301 of H.R. 8900, which passed the House on December 9, passed the Senate on December 11, and was signed into law by the President that night.  MARC is particularly grateful to Senator Tim Scott, Senator Ben Cardin, Congressman Ron Kind, and ​​Congressman Gus Bilirakis for leading the Congressional effort, and thanks the Members and their tireless staff for all their help and assistance on securing this important legislative success and improvement in MSP Policy.   For more information on the PAID Act bill efforts click here. 

WASHINGTON, DC – In a letter addressed to Senators Tim Scott (R-SC) and Ben Cardin (D-MD), seventeen organizations and companies representing the Medicare Secondary Payer-regulated community urged Congress to pass the bipartisan Provide Accurate Information Directly (PAID) Act (S.1989/H.R.1375).
 
“On behalf of the Medicare Advocacy Recovery Coalition (MARC), we are writing to thank you both for your continued leadership in advocating for the Provide Accurate Information Directly Act and to communicate our strong support for this important legislation,” the letter reads. “As you know, the current law continues to create an inefficient system for all parties trying to navigate the Medicare Secondary Payer statute which involves Medicare Advantage and Medicare Prescription Drug Benefit claims. The passage and enactment of the bipartisan PAID Act is needed to correct this inefficient process and ensure that every stakeholder is given the accurate information needed to resolve claims quickly and save taxpayers millions of dollars in the process.”
 
About the PAID Act
Currently, when a Medicare beneficiary with a Medicare Advantage or Part D prescription drug plan is involved in a situation where their medical expenses are the responsibility or another party through either a settlement, judgement, or other award, the law recognizes that the plan’s responsibility to pay for the beneficiary’s treatment can in certain instances be “secondary.”
 
However, the process by which the Centers for Medicare & Medicaid Services (CMS) coordinates benefits with settling parties is currently broken when it comes to recoupment of claims related to Medicare Advantage and Part D plans. That’s because, unlike traditional Medicare, settling parties have no way to determine which MA or Part D plan a beneficiary is enrolled in and cannot determine their reimbursement obligations, if there are any. This results in settling parties closing claim files only to find out a year or more later that they may have a reimbursement obligation. For beneficiaries, this could result in a loss of a settlement, and possibly even care delays, as both the settling party and MA or Part D Plans try to reconcile their respective records.
 
The PAID Act ­– which was introduced by Senators Scott (R-SC) and Cardin (D-MD) in the Senate and Representatives Ron Kind (D-WI) and Gus Bilirakis (R-FL) in the House – would fix this issue by requiring CMS to share necessary information with settling parties. Through the Section 111 query process, a system that already exists to share information between Medicare and third parties, settling parties would have access to the name of the beneficiary’s plan and the dates of coverage – which is all that is needed to coordinate benefits.
 
To view the full letter and list of signatories, CLICK HERE.
 
 
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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 or liability 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.

By Angela Childers|February 26, 2020
Business Sources

A long-awaited proposed rule regarding late reporting of Medicare Secondary Payer data could mean potentially significant penalties for workers compensation insurers, self-insured entities and others.
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The Centers for Medicare & Medicaid Services released the proposed rule for Section 111 reporting on Feb. 18 — seven years after it first accepted comments on the issue of penalties for failure to accurately report Medicare Secondary Payer data and 13 years after the creation of Section 111.

WASHINGTON, DC – The Medicare Advocacy Recovery Coalition (MARC) Chair Re Knack today issued the following statement regarding the Centers for Medicare and Medicaid Services (CMS) release of a proposed rule concerning how it will assess penalties for Medicare Secondary Payer (MSP) late reporting:

By Roy Franco|December 12, 2019
Inside Sources

The deadline has come and gone, and Congress is still working on funding the government for the fiscal year. In late November, lawmakers passed a continuing resolution to give themselves another month to pass required appropriations bills, but important questions remain on how to fund key tax and spending proposals. 

No doubt lawmakers will be looking for any savings they can get. Here’s an idea that is projected to save the government millions of dollars per year while fixing a misunderstood Medicare program that has caused insurer, risk manager and Medicare beneficiary headaches for decades. It’s called the Provide Accurate Information Directly (PAID) Act, and it’s a plan to fix America’s broken Medicare Secondary Payer (MSP) process. 

By Nathaniel F. Wienecke | August 6, 2019
Claims Journal

It’s a scenario every senior citizen fears—getting seriously injured in an accident. Whether it’s a slip and fall at the grocery store or getting hit by a car crossing the street, the question of “who pays?” often isn’t far from anyone’s mind. Luckily for most Medicare beneficiaries, there is a process in place to make sure they receive the care they need in a timely matter.
Still, Medicare is not necessarily responsible for paying for care in cases where another party is liable for a beneficiary’s healthcare expenses resulting from an accident. The Medicare Secondary Payer (MSP) system, as it is called, was created by Congress in 1980 to allow Medicare to pay for health care costs and then get repaid after the beneficiary received a settlement, judgement, or other award where medical expenses are involved for the same injury.

WASHINGTON, DC – The Medicare Advocacy Recovery Coalition (MARC) today commended Senators Tim Scott (R-SC) and Ben Cardin (D-MD) for introducing the Provide Accurate Information Directly Act (PAID Act) (S. 1989), a bipartisan bill to improve the Medicare Secondary Payer process and provide a clear framework to enable the smoother coordination of benefits between settling parties and private Medicare plans. A companion bill (H.R. 1375) sponsored by Representatives Ron Kind (D-WI) and Gus Bilirakis (R-FL) was introduced in the House of Representatives in February.
 
“We applaud Senators Scott and Cardin for working together on a bipartisan solution to fix the broken Medicare Secondary Payer process,” said Re Knack, Chair of MARC, DRI Member and Chair Emeritus for DRI’s MSP Task Force. “The PAID Act will establish a clear process for sharing information between settling parties and private Medicare plans to ensure claims can be resolved promptly and beneficiaries can receive what they are owed.”
 
Currently, when a Medicare beneficiary with a Medicare Advantage or Part D prescription drug plan is involved in a situation where their medical expenses are the responsibility or another party through either a settlement, judgement, or other award, the law recognizes that the plan’s responsibility to pay for the beneficiary’s treatment can in certain instances be “secondary.”
 
However, the process by which the Centers for Medicare & Medicaid Services (CMS) coordinates benefits with settling parties is currently broken when it comes to recoupment of claims related to Medicare Advantage and Part D plans. That’s because, unlike traditional Medicare, settling parties have no way to determine which MA or Part D plan a beneficiary is enrolled in and cannot determine their reimbursement obligations, if any. This results in settling parties closing claim files only to find out a year or more later that they may have a reimbursement obligation. For beneficiaries, this could result in a loss of a settlement, and possibly even care delays, as both the settling party and MA or Part D Plans try to reconcile their respective records.
 
The PAID Act fixes this issue by requiring CMS to share necessary information with settling parties - namely the names of the plans and the dates of coverage - through the section 111 query process, a system that already exists to share information between Medicare and third parties.
 
“We need Congress to act now to create a more efficient solution for beneficiaries, taxpayers, and employers,” Knack concluded. “The PAID Act is a bipartisan solution that’s a win-win-win for everyone.  We truly appreciate Senator Scott and Senator Cardin for their leadership on this common sense legislation that will improve the lives of millions of Medicare beneficiaries in South Carolina, Maryland and across the country.”
 
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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.
 

BY RON KIND & GUS BILIRAKIS
MORNING CONSULT

Every year, an estimated 500,000 personal injury-related cases are settled in the United States, by far the largest area of civil litigation in the country. Tort cases, workers compensation claims and even auto accidents typically lead to a settlement where the liable party must pay for an individual’s medical expenses. While this process is usually relatively straightforward, that’s not always the case when Medicare beneficiaries are involved.

That’s because in cases where an injured party is covered by the Medicare program, the law recognizes that Medicare’s responsibility to pay for a beneficiary’s health care expenses is secondary to the party’s private insurer. This well-established policy is designed to ensure taxpayers don’t foot the bill to cover health care expenses for which another private payer is responsible.

However, the process by which Medicare recuperates payment for these claims — known as the Medicare Secondary Payer process — is broken, especially in situations where a beneficiary is covered by a Medicare Advantage or Part D plan. The problem is that settling parties have no way to find out in which Medicare plan the beneficiary participates and therefore cannot coordinate benefits or repay what is owed. And it is not from lack of trying, either.

For example, say a Medicare beneficiary enrolled in an MA plan has a slip and fall accident while shopping at a local business and is rushed to the hospital for a broken hip. The Medicare plan pays the hospital bills. However, a subsequent personal injury lawsuit results in a settlement including the medical costs.

How does the settling party repay a Medicare Advantage plan? The answer should come from the Centers for Medicare and Medicaid Services — the government agency that oversees the Medicare program — but CMS today will not tell the settling parties what MA plan a beneficiary is even in.

If that person had been covered by traditional Medicare, the Medicare Secondary Payer Act establishes a clear process for payment. But for individuals enrolled in MA plans — which cover 22.4 million Americans as of this year — there is no such process. Businesses wanting to do the right thing are left in the dark about how much they owe and to whom. The result: headaches all around.

It simply doesn’t have to be this way. Congress has an opportunity to make some common-sense reforms to the arcane Medicare Secondary Payer process to offer a simple and taxpayer-friendly solution to this problem. It requires more information sharing between CMS and settling parties — such as whether the beneficiary is enrolled in an MA or Part D plan along with the name and identity of the plan and dates of coverage.

That’s why we recently introduced H.R. 1375, the Provide Accurate Information Directly Act, which accomplishes this goal by requiring CMS to share needed information with third-party plans. With just one small legislative change, Congress can create a smoother, speedier and fairer claims process for all parties involved — a rare opportunity in a time of political division.

We encourage our colleagues to co-sponsor this legislation that will bring immediate tangible benefits to beneficiaries, businesses and most importantly — taxpayers.

​Rep. Ron Kind (D) represents the 3rd District of Wisconsin, and Rep. Gus Bilirakis (R) represents the 12th District of Florida.

BY RE KNACK, OPINION CONTRIBUTOR
THE HILL​
Accidents happen every day. From a slip-and-fall at the shopping center to fender-benders on the highway, to more serious cases involving life-threatening injuries. Often these situations resolve through a negotiated settlement, where the entity alleged to have caused the accident ends up settling a portion of the individual’s claims, including claims for medical expenses. In cases where the injured party’s health care is covered by the Medicare program, however, things can get tricky very quickly. 

Take, for example, a slip-and-fall incident, where the injured person’s medical bills are covered by the business where the incident took place. Sometimes, this process is relatively straightforward. The injured person has Medicare pay the initial bill for medical care. Then the injured party brings a claim against the business and they end up settling. Under the law, both the injured party and the business are responsible for paying Medicare back what Medicare paid for the cost of hospital and follow up care. This happens because, in cases like this, the law requires that Medicare serve as the secondary payer to protect taxpayers from having to cover expenses for which another party is liable.

It’s a policy that works. Since the Medicare Secondary Payer (MSP) Act was passed in 1980, the Medicare program recuperates nearly $8 billion in direct savings to taxpayers annually. 

Now what happens if the injured person is one of the 22 million Americans with a Medicare Advantage plan instead of the traditional Medicare Part A or B? You would think the settling party would just be able to pay back the government the same way it would if the injured person had been on traditional Medicare. Unfortunately, it doesn’t work that way. The system the Centers for Medicare & Medicaid Services (CMS) has in place to help settling parties coordinate benefits for traditional Medicare has not been set up for Medicare Advantage or Part D prescription drug plans. As a result, there is essentially no transparency and settling parties are unable to even find out which Medicare Advantage or Part D plan the beneficiary has to settle the claim, much less actually resolve a claim if one exists.

This broken process means a claim can stay open for months or even years or be settled with everyone believing it is over, only to years later be confronted with a claim by the Medicare Advantage or Part D plan. Worst case, vulnerable Medicare beneficiaries are placed in the middle, with the risk of having their Medicare benefits turned off due to an unresolved claim – possibly one, two or even five years down the road. Once this occurs, the beneficiary is responsible for covering future health care costs out of his own pocket – potentially for care both related and unrelated to the original accident.

The American taxpayer also loses in this scenario. Because the business where the accident took place doesn’t know which Medicare Advantage plan it needs to pay in order to resolve the claim, the government isn’t getting the money it’s owed. And there’s potentially a lot of money at stake. According to Kaiser Family Foundation, Medicare spent close to $210 billion on Medicare Advantage plans in 2017. Considering approximately 12 percent of claims likely involved a Medicare beneficiary, that means about $25 billion in taxpayer money is on the line.
There’s no reason for things to be this complicated – or for taxpayers to be losing out on this much money. In fact, it’s pretty remarkable that CMS isn’t able to disclose this information to settling parties who want to do the right thing and pay what they owe. 

The good news is that there’s bipartisan legislation to address this issue and require CMS to share information about whether a beneficiary is enrolled in a Medicare Advantage or Part D plan along with the plan’s name and dates of coverage, so the settling parties know who to pay. The Provide Accurate Information Directly (PAID) Act H.R. 1375 sponsored by Reps. Ron Kind (D-Wis.) and Gus Bilirakis (R-Fla.) would allow CMS to make this information available under the “Section 111” query process, the system already in place to share information between Medicare and third parties in cases where the claimant has traditional Medicare. 

Older Americans on Medicare shouldn’t face care delays or unexpected health care costs because of a broken provision in the obscure Medicare Secondary Payer Act. Congress has a real opportunity to fix this issue in a bipartisan way and make the process smoother and fairer for everyone. Many stakeholders, including the Congressional Budget Office, have recognized that this will save Medicare money immediately. Congress should act now and resolve this issue once and for all. 

Re Knack is Chair of the Medicare Advocacy Recovery Coalition (MARC), a national coalition advocating for the improvement of the Medicare and Medicaid Secondary Payer programs, she is also Chair Emeritus for DRI’s MSP Task Force and a member at Ogden Murphy Wallace in Seattle, Wash., where she represents clients in insurance and health care matters.