Recent Medicare Set-Aside Changes

An expert recaps what's new for LMSAs, WCMSAs, and more

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Recent Medicare Set-Aside Changes, by Jennifer C. Jordan, Esq., General Counsel, MEDVAL, LLC. Liability Medicare Set Asides.Of the series of memos released by CMS on September 30, 2011, the most notable established a policy for when a liability Medicare set-aside (LMSA) would not be required. This is the first official policy published by CMS that even addresses the concept of LMSAs. Because CMS had remained silent on the issue for nearly a decade, many believed that MSAs were limited in application to workers' compensation. So not only does the memo create an absolute exemption for the need to create an LMSA under certain circumstance, but it also infers the inverse in that should you fail to obtain the necessary physician certification that no future medical treatment is required, then Medicare just may have an interest in need of protection. The election to handle the issue in this manner was frankly brilliant on CMS' part because it was able to establish the need to consider an LMSA without providing any criteria for how to do it. > Read more.

The Sticky Wicket That Is Home Health Care: Why It's a Hotly Contested Issue in the Workers' Compensation Arena, by Robin E. Kobayashi. An injured employee's entitlement to home health care is oftentimes a hotly contested issue in the workers' compensation arena. Home health care issues can vary in nature. For instance, at what point does the marital obligation cease and the paid nursing services begin? Another issue in these cases may involve the level of skill involved; the number of hours in a 24-hour period assistance is needed, not to mention the appropriate hourly rate at which the services should be paid. As an example of the potential dollars involved in these cases, if a spouse is providing services for 24 hours per day, at an LVN skill level, assuming an hourly rate of $25 per hour, and assuming a life expectancy of 35 years, the future value of these services amounts to over $7.6 million. After doing the math, it is easy to see why a great deal of litigation surrounds these particular issues. Find out how four states have recently dealt with some of these issues. > Read more.

CA: WCIRB Report Says WC Costs Rose Slightly in 2011.

CA: Senate Committee to Hold SB 899 Impact on Permanent Disability Hearing March 28.

CA: DIR Announces Additional Sessions for Workers Comp Forums.

CA: Poms & Associates Names Flannery VP of P/C Group.

CA: CWCDAA Launches Facebook Page.

CO: HB 1033 DWC Assessment of Late Reporting Fines Sent to Governor.

CO: Governor, Pinnacol Renew Efforts for Privatization.

CO: DWC Releases 2011 Injured Worker Exit Survey Results.

DE: OWC Launches New Continuing Education Course for Health Care Providers.

FL: HB 5203, Outsourcing of Vocational Rehab of Injured Workers, Sent to Governor.

FL: FWCI Inducts Charter Members Into Workers Comp Hall of Fame.

FL: State Senator Blames GOP Lawmakers for Failure to Close Prescription Drug Loophole.

FL: HB 941 WC Insurance Excess Profits and Premiums Bill Sent to Governor.

GA: Court Reverses Ruling Allowing Doctors to Talk Ex Parte With Injured Worker's Employer.

HI: Senate Committee Approves HB 2574 on Notice of Hearings.

HI: Senate Committee Approves HB 2584 on Notice of Employer's WC Coverage.

ID: Senate Passes Bill to Help Firefighters Who Contract Cancer.

IL: Chairman Weisz Appoints Self-Insurers Advisory Board Members.

IL: IWCC Files Proposed Changes to Fee Schedule Rules.