THE PAID ACT
December 11, 2020
MARC CONGRATULATES THE CONGRESS ON PASSING THE PAID ACT
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.
What does the PAID Act Do? Effective December 11, 2021, CMS is required to provide any Responsible Reporting Entity (RRE, the insurer or self-insured), in response to a Section 111 “query,” with the name, address and plan number of each Medicare Advantage (Part C) and Medicare Prescription Drug (Part D) Plan into which a Medicare beneficiary was enrolled for the three years prior to the date of the query. This will allow those RREs who wish to do so to coordinate benefits with the Medicare Advantage and Part D Plans and resolve any outstanding claims that such Plans might assert for payments related to an accident or injury subject to a settlement, judgment or award paid by the RRE.
What Does the PAID Act Change? The PAID Act improves the information flow between parties to improve claims coordination and repayment. Importantly, the PAID Act does not change any legal obligations. As the legislative history of the PAID Act makes clear, Medicare Advantage and Part D Plans are still obligated not to pay health claims where another party is available to pay or is reasonably expected to pay, and to the extent that Medicare Advantage and Part D Plans properly pay claims when payment is not otherwise available it remains the obligation of those Plans to submit a claim for repayment to the “primary plan” that the Medicare Advantage or Part D Plan believes is responsible for payment. Similarly, CMS continues to be responsible for sending RRE’s Section 111 reports to the Medicare Advantage and Part D Plans so that those Plans can seek recovery. Insurers and Self-Insureds do not have any new legal obligation to coordinate benefits and reach out to the Plans -- they may do so if they so choose, at their option. The legal obligation remains with the Medicare Advantage Plans and Part D Plans to seek recovery by presenting claims for repayment before the they can take any further action, including litigation.
Why Was the Legislation Needed? Historically Medicare Advantage and Part D Plans have often failed to pursue collections, or “secondary payer” amounts from primary plans. Yet, several Medicare Advantage Plans have, years after the fact, sued Medicare beneficiaries, their attorneys, and the parties paying those settlements for repayment.
For example, in a Louisiana case called Collins v. Wellcare, a Medicare Advantage Plan successfully sued a beneficiary for repayment of medical claims arising from an auto accident. Similarly, in a Virginia case called Humana v. Paris Blank, a Medicare Advantage Plan successfully sued a beneficiary’s attorney for recovery of medical costs from an auto accident.
Pharmaceutical companies and insurance companies have also been sued under these same theories.
The parties paying the settlements never had the opportunity to resolve the claims with the Medicare Advantage and Part D Plans at the time of settlement because they could not determine or identify the specific Medicare Advantage and Part D Plan. The PAID Act solves this problem, providing the settling parties paying the claim the ability to identify the Plans so they can resolve outstanding claims and give Medicare beneficiaries finality and peace of mind, as well as saving the U.S. taxpayer money in the process.
PAID Act History:
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.
What does the PAID Act Do? Effective December 11, 2021, CMS is required to provide any Responsible Reporting Entity (RRE, the insurer or self-insured), in response to a Section 111 “query,” with the name, address and plan number of each Medicare Advantage (Part C) and Medicare Prescription Drug (Part D) Plan into which a Medicare beneficiary was enrolled for the three years prior to the date of the query. This will allow those RREs who wish to do so to coordinate benefits with the Medicare Advantage and Part D Plans and resolve any outstanding claims that such Plans might assert for payments related to an accident or injury subject to a settlement, judgment or award paid by the RRE.
What Does the PAID Act Change? The PAID Act improves the information flow between parties to improve claims coordination and repayment. Importantly, the PAID Act does not change any legal obligations. As the legislative history of the PAID Act makes clear, Medicare Advantage and Part D Plans are still obligated not to pay health claims where another party is available to pay or is reasonably expected to pay, and to the extent that Medicare Advantage and Part D Plans properly pay claims when payment is not otherwise available it remains the obligation of those Plans to submit a claim for repayment to the “primary plan” that the Medicare Advantage or Part D Plan believes is responsible for payment. Similarly, CMS continues to be responsible for sending RRE’s Section 111 reports to the Medicare Advantage and Part D Plans so that those Plans can seek recovery. Insurers and Self-Insureds do not have any new legal obligation to coordinate benefits and reach out to the Plans -- they may do so if they so choose, at their option. The legal obligation remains with the Medicare Advantage Plans and Part D Plans to seek recovery by presenting claims for repayment before the they can take any further action, including litigation.
Why Was the Legislation Needed? Historically Medicare Advantage and Part D Plans have often failed to pursue collections, or “secondary payer” amounts from primary plans. Yet, several Medicare Advantage Plans have, years after the fact, sued Medicare beneficiaries, their attorneys, and the parties paying those settlements for repayment.
For example, in a Louisiana case called Collins v. Wellcare, a Medicare Advantage Plan successfully sued a beneficiary for repayment of medical claims arising from an auto accident. Similarly, in a Virginia case called Humana v. Paris Blank, a Medicare Advantage Plan successfully sued a beneficiary’s attorney for recovery of medical costs from an auto accident.
Pharmaceutical companies and insurance companies have also been sued under these same theories.
The parties paying the settlements never had the opportunity to resolve the claims with the Medicare Advantage and Part D Plans at the time of settlement because they could not determine or identify the specific Medicare Advantage and Part D Plan. The PAID Act solves this problem, providing the settling parties paying the claim the ability to identify the Plans so they can resolve outstanding claims and give Medicare beneficiaries finality and peace of mind, as well as saving the U.S. taxpayer money in the process.
PAID Act History:
- PAID Act Infographic
- PAID Act Video
- Provide Accurate Information Directly (PAID) Act H.R. 1375 - Section by Section
- Provide Accurate Information Directly (PAID) Act S. 1989 - Section by Section
- Inside Sources: Fix Medicare’s Broken Secondary Payer System, December 12, 2019
- MARC Release: MARC Applauds PAID Act Introduction in Senate, June 27, 2019
- Morning Consult: Fix Medicare Secondary Payer System for Responsible Organizations to Seeking to Settle, Reps. Ron Kind and Gus Bilirakis, April 18, 2019
- The Hill: Congress Must Fix the Broken MSP Process, March 28, 2019
- MARC Release: MARC Applauds Bipartisan Bill to Improve Medicare Secondary Payer Policy, February 28, 2019
- MARC Letter to Seema Verma, Administrator, CMS - CMS-4182-P: 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, January 11, 2018
