II 

114TH CONGRESS 

1ST SESSION S. 1514 

To amend title XVIII of the Social Security Act to provide for the application 

of Medicare secondary payer rules to certain workers’ compensation settlement agreements and qualified Medicare set-aside provisions. 

IN THE SENATE OF THE UNITED STATES 

JUNE 4, 2015 

Mr. PORTMAN (for himself and Mr. NELSON) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for the application of Medicare secondary payer rules 

to certain workers’ compensation settlement agreements 

and qualified Medicare set-aside provisions. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Secondary 

5 Payer and Workers’ Compensation Settlement Agree6 ments Act of 2015’’. 


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1 SEC. 2. APPLICATION OF MEDICARE SECONDARY PAYER 

2 RULES TO CERTAIN WORKERS’ COMPENSA3 TION SETTLEMENT AGREEMENTS AND 

4 QUALIFIED MEDICARE SET-ASIDE PROVI5 SIONS. 

6 (a) THRESHOLD FOR SECONDARY PAYER PROVI7 SIONS FOR CERTAIN WORKERS’ COMPENSATION SETTLE8 MENT AGREEMENTS.—Section 1862 of the Social Security 

9 Act (42 U.S.C. 1395y) is amended— 

10 (1) in subsection (b)(2)(A)(ii), by inserting 

11 ‘‘subject to subsection (p),’’ after ‘‘(ii)’’; and 

12 (2) by adding at the end the following new sub13 section: 

14 ‘‘(p) THRESHOLD FOR SECONDARY PAYER PROVI15 SIONS FOR CERTAIN WORKERS’ COMPENSATION SETTLE16 MENT AGREEMENTS.— 

17 ‘‘(1) IN GENERAL.—A workers’ compensation 

18 law or plan shall not be treated as a primary plan 

19 for purposes of subsection (b) with respect to a 

20 workers’ compensation settlement agreement if the 

21 agreement (or claimant under the agreement) meets 

22 any of the following requirements: 

23 ‘‘(A) TOTAL SETTLEMENT AMOUNT NOT

24 EXCEEDING $25,000.—Such agreement has a 

25 total settlement amount (as determined under 

26 paragraph (2)) that does not exceed $25,000 or 


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1 such greater amount as the Secretary may 

2 specify in regulations. 

3 ‘‘(B) LIKELY INELIGIBILITY OF WORKERS’ 

4 COMPENSATION CLAIMANT FOR MEDICARE BEN5 EFITS.—The claimant subject to such agree6 ment— 

7 ‘‘(i) is not eligible for benefits under 

8 this title as of the effective date of the 

9 agreement; and 

10 ‘‘(ii) is unlikely to become so eligible, 

11 as determined under paragraph (3), within 

12 30 months after such effective date. 

13 ‘‘(C) NO FUTURE WORKERS’ COMPENSA14 TION MEDICAL EXPENSES.—The claimant sub15 ject to such agreement is not eligible for pay16 ment of medical expenses incurred after the ef17 fective date of the agreement from the workers’ 

18 compensation law or plan of the jurisdiction in 

19 which such agreement will be effective. 

20 ‘‘(D) NO LIMITATION ON FUTURE WORK21 ERS’ COMPENSATION MEDICAL EXPENSES.— 

22 Such agreement does not limit or extinguish the 

23 right of the claimant to payment of medical ex24 penses incurred after the effective date of such 

25 agreement by the workers’ compensation law or 


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1 plan of the jurisdiction in which the agreement 

2 will be effective. 

3 ‘‘(2) DETERMINATION OF TOTAL SETTLEMENT

4 AMOUNT OF WORKERS’ COMPENSATION SETTLE5 MENT AGREEMENT.—For purposes of paragraph 

6 (1)(A) and subsection (q) and with respect to a 

7 work-related injury or illness that is the subject of 

8 a workers’ compensation settlement agreement, the 

9 total settlement amount of the agreement is the sum 

10 of monetary wage replacement benefits, attorney 

11 fees, all future medical expenses, repayment of Medi12 care conditional payments, payout totals for annu13 ities to fund the expenses listed above, and any pre14 viously settled portion of the workers’ compensation 

15 claim. 

16 ‘‘(3) DETERMINATION OF LIKELY INELIGI17 BILITY OF CLAIMANT FOR MEDICARE BENEFITS.— 

18 For purposes of paragraph (1)(B)(ii), a workers’ 

19 compensation claimant shall be deemed unlikely to 

20 become eligible for benefits under this title within 30 

21 months after the effective date of the agreement un22 less, as of the effective date of the agreement, such 

23 claimant is insured for disability insurance benefits 

24 under section 223(c)(1) and is described in any of 

25 the following subparagraphs: 


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1 ‘‘(A) AWARDED DISABILITY BENEFITS.— 

2 The individual has been awarded such disability 

3 insurance benefits. 

4 ‘‘(B) APPLIED FOR DISABILITY.—The indi5 vidual has applied for such disability insurance 

6 benefits. 

7 ‘‘(C) ANTICIPATES APPEAL.—The indi8 vidual has been denied such disability insurance 

9 benefits but anticipates appealing that decision. 

10 ‘‘(D) APPEALING OR REFILING.—The indi11 vidual is in the process of appealing or refiling 

12 for such disability insurance benefits. 

13 ‘‘(E) MINIMUM AGE.—The individual is at 

14 least 62 years and 6 months of age. 

15 ‘‘(F) END-STAGE RENAL DISEASE.—The 

16 individual is medically determined to have end17 stage renal disease but does not yet qualify for 

18 health benefits under section 226A based on 

19 such disease. 

20 ‘‘(4) DEFINITIONS.—For purposes of this sub21 section and subsection (q): 

22 ‘‘(A) COMPROMISE AGREEMENT.—The 

23 term ‘compromise agreement’ means a workers’ 

24 compensation settlement agreement that— 


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1 ‘‘(i) applies to a workers’ compensa2 tion claim that is denied or contested, in 

3 whole or in part, by a workers’ compensa4 tion payer involved under the workers’ 

5 compensation law or plan applicable to the 

6 jurisdiction in which the agreement has 

7 been settled; and 

8 ‘‘(ii) does not provide for a payment 

9 of the full amount of benefits sought or 

10 that may be payable under the workers’ 

11 compensation claim. 

12 ‘‘(B) COMMUTATION AGREEMENT.—The 

13 term ‘commutation agreement’ means a work14 ers’ compensation settlement agreement to set15 tle all or a portion of a workers’ compensation 

16 claim, in which— 

17 ‘‘(i) liability for past and future bene18 fits is not disputed; and 

19 ‘‘(ii) the parties to the agreement 

20 agree to include payment for future work21 ers’ compensation benefits payable after 

22 the date on which the agreement becomes 

23 effective. 


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1 ‘‘(C) WORKERS’ COMPENSATION CLAIM2 ANT.—The term ‘workers’ compensation claim3 ant’ means a worker who— 

4 ‘‘(i) is or may be covered under a 

5 workers’ compensation law or plan; and 

6 ‘‘(ii) submits a claim or accepts bene7 fits under such law or plan for a work-re8 lated injury or illness. 

9 ‘‘(D) WORKERS’ COMPENSATION LAW OR

10 PLAN.— 

11 ‘‘(i) IN GENERAL.—The term ‘work12 ers’ compensation law or plan’ means a 

13 law or program administered by a State or 

14 the United States to provide compensation 

15 to workers for a work-related injury or ill16 ness (or for disability or death caused by 

17 such an injury or illness), including the 

18 Longshore and Harbor Workers’ Com19 pensation Act (33 U.S.C. 901–944, 948– 

20 950), chapter 81 of title 5, United States 

21 Code (known as the Federal Employees 

22 Compensation Act), the Black Lung Bene23 fits Act (30 U.S.C. 931 et seq.), and part 

24 C of title 4 of the Federal Coal Mine and 

25 Safety Act (30 U.S.C. 901 et seq.), but not 


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1 including the Act of April 22, 1908 (45 

2 U.S.C. 51 et seq.) (popularly referred to as 

3 the Federal Employer’s Liability Act). 

4 ‘‘(ii) INCLUSION OF SIMILAR COM5 PENSATION PLAN.—Such term includes a 

6 similar compensation plan established by 

7 an employer that is funded by such em8 ployer or the insurance carrier of such em9 ployer to provide compensation to a worker 

10 of such employer for a work-related injury 

11 or illness. 

12 ‘‘(E) WORKERS’ COMPENSATION PAYER.— 

13 The term ‘workers’ compensation payer’ means, 

14 with respect to a workers’ compensation law or 

15 plan, a workers’ compensation insurer, self-in16 surer, employer, individual, or any other entity 

17 that is or may be liable for the payment of ben18 efits to a workers’ compensation claimant pur19 suant to the workers’ compensation law or plan. 

20 ‘‘(F) WORKERS’ COMPENSATION SETTLE21 MENT AGREEMENT.—The term ‘workers’ com22 pensation settlement agreement’ means an 

23 agreement, which includes a commutation 

24 agreement or compromise agreement, or any 

25 combination of both, between a claimant and 


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1 one or more workers’ compensation payers 

2 which— 

3 ‘‘(i) forecloses the possibility of future 

4 payment of some or all workers’ compensa5 tion benefits involved; and 

6 ‘‘(ii)(I) compensates the claimant for 

7 a work-related injury or illness as provided 

8 for by a workers’ compensation law or 

9 plan; or 

10 ‘‘(II) eliminates cause for litigation in11 volving issues in dispute between the 

12 claimant and payer.’’. 

13 (b) SATISFACTION OF SECONDARY PAYER REQUIRE14 MENTS THROUGH USE OF QUALIFIED MEDICARE SET15 ASIDES UNDER WORKERS’ COMPENSATION SETTLEMENT

16 AGREEMENTS.—Section 1862 of the Social Security Act 

17 (42 U.S.C. 1395y), as amended by subsection (a), is fur18 ther amended by adding at the end the following new sub19 section: 

20 ‘‘(q) TREATMENT OF QUALIFIED MEDICARE SET21 ASIDES UNDER WORKERS’ COMPENSATION SETTLEMENT

22 AGREEMENTS.— 

23 ‘‘(1) SATISFACTION OF SECONDARY PAYER RE24 QUIREMENTS THROUGH USE OF QUALIFIED MEDI25 CARE SET-ASIDES.— 


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1 ‘‘(A) FULL SATISFACTION OF CLAIM OBLI2 GATIONS.— 

3 ‘‘(i) IN GENERAL.—If a workers’ com4 pensation settlement agreement, related to 

5 a claim of a workers’ compensation claim6 ant, includes a qualified Medicare set-aside 

7 (as defined in paragraph (2)), such set8 aside shall satisfy any obligation with re9 spect to the future payment reimbursement 

10 under subsection (b)(2) with respect to 

11 such claim. 

12 ‘‘(ii) RULE OF CONSTRUCTION.— 

13 Nothing in this section shall be construed 

14 as requiring the submission of a Medicare 

15 set-aside to the Secretary. 

16 ‘‘(B) MEDICARE SET-ASIDE AND MEDI17 CARE SET-ASIDE AMOUNT DEFINED.—For pur18 poses of this subsection: 

19 ‘‘(i) MEDICARE SET-ASIDE.—The 

20 term ‘Medicare set-aside’ means, with re21 spect to a workers’ compensation settle22 ment agreement, a provision in the agree23 ment that provides for a payment of a 

24 lump sum, annuity, a combination of a 

25 lump sum and an annuity, or other 


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1 amount that is in full satisfaction of the 

2 obligation described in subparagraph (A) 

3 for items and services that the workers’ 

4 compensation claimant under the agree5 ment received or is likely to receive under 

6 the applicable workers’ compensation law 

7 and for which payment would be made 

8 under this title, but for subsection 

9 (b)(2)(A). 

10 ‘‘(ii) MEDICARE SET-ASIDE

11 AMOUNT.—The term ‘Medicare set-aside 

12 amount’ means, with respect to a Medicare 

13 set-aside, the actual dollar amount pro14 vided for in clause (i). 

15 ‘‘(2) QUALIFIED MEDICARE SET-ASIDE.— 

16 ‘‘(A) REQUIREMENTS OF QUALIFIED MEDI17 CARE SET-ASIDE.—For purposes of this sub18 section, a Medicare set-aside shall be deemed to 

19 be a qualified Medicare set-aside if the Medi20 care set-aside amount reasonably takes into ac21 count the full payment obligation described in 

22 paragraph (1)(A), while meeting the require23 ments of subparagraphs (B) and (C) and is de24 termined based on the following: 


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1 ‘‘(i) The illness or injury giving rise to 

2 the workers’ compensation claim involved. 

3 ‘‘(ii) The age and life expectancy of 

4 the claimant involved. 

5 ‘‘(iii) The reasonableness of and ne6 cessity for future medical expenses for 

7 treatment of the illness or injury involved. 

8 ‘‘(iv) The duration of and limitation 

9 on benefits payable under the workers’ 

10 compensation law or plan involved. 

11 ‘‘(v) The regulations and case law rel12 evant to the State workers’ compensation 

13 law or plan involved. 

14 ‘‘(B) ITEMS AND SERVICES INCLUDED.—A 

15 qualified Medicare set-aside— 

16 ‘‘(i) shall include payment for items 

17 and services that are covered and otherwise 

18 payable under this title as of the effective 

19 date of the workers’ compensation settle20 ment agreement and that are covered by 

21 the workers’ compensation law or plan; 

22 and 

23 ‘‘(ii) is not required to provide for 

24 payment for items and services that are 

25 not described in clause (i). 


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1 ‘‘(C) PAYMENT REQUIREMENTS.— 

2 ‘‘(i) REQUIRED USE OF WORKERS’ 

3 COMPENSATION FEE SCHEDULE.— 

4 ‘‘(I) IN GENERAL.—Except in the 

5 case of an optional direct payment of 

6 a Medicare set-aside made under 

7 paragraph (5)(A), the set-aside 

8 amount shall be based upon the pay9 ment amount for items and services 

10 under the workers’ compensation fee 

11 schedule (effective as of the date of 

12 the agreement) applicable to the work13 ers’ compensation law or plan in14 volved. 

15 ‘‘(II) WORKERS’ COMPENSATION

16 FEE SCHEDULE DEFINED.—For pur17 poses of this subsection, the term 

18 ‘workers’ compensation fee schedule’ 

19 means, with respect to a workers’ 

20 compensation law or plan of a State 

21 or a similar plan applicable in a State, 

22 the schedule of payment amounts the 

23 State has established to pay providers 

24 for items and services furnished to 

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1 jury or illness as defined under such 

2 law or plan (or in the absence of such 

3 a schedule, the applicable medical re4 imbursement rate under such law or 

5 plan). 

6 ‘‘(ii) OPTIONAL PROPORTIONAL AD7 JUSTMENT FOR COMPROMISE SETTLEMENT

8 AGREEMENTS.— 

9 ‘‘(I) IN GENERAL.—In the case 

10 of a compromise settlement agree11 ment, a claimant or workers’ com12 pensation payer who is party to the 

13 agreement may elect to calculate the 

14 Medicare set-aside amount of the 

15 agreement by applying a percentage 

16 reduction to the Medicare set-aside 

17 amount for the total settlement 

18 amount that could have been payable 

19 under the applicable workers’ com20 pensation law or similar plan involved 

21 had the denied, disputed, or contested 

22 portion of the claim not been subject 

23 to a compromise agreement. The per24 centage reduction shall be equal to the 

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1 age of such total settlement. Such 

2 election may be made by a party to 

3 the agreement only with the written 

4 consent of the other party to the 

5 agreement. 

6 ‘‘(II) APPLICATION.—If the 

7 claimant or workers’ compensation 

8 payer elects to calculate the Medicare 

9 set-aside amount under this clause, 

10 the Medicare set-aside shall be 

11 deemed a qualified Medicare set-aside. 

12 ‘‘(3) PROCESS FOR APPROVAL OF QUALIFIED

13 MEDICARE SET-ASIDES.— 

14 ‘‘(A) OPTIONAL PRIOR APPROVAL BY SEC15 RETARY.—A party to a workers’ compensation 

16 settlement agreement that includes a Medicare 

17 set-aside may submit to the Secretary the Medi18 care set-aside amount for approval of the set19 aside as a qualified Medicare set-aside. 

20 ‘‘(B) NOTICE OF DETERMINATION OF AP21 PROVAL OR DISAPPROVAL.—Not later than 60 

22 days after the date on which the Secretary re23 ceives a submission under subparagraph (A), 

24 the Secretary shall notify in writing the parties 

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1 ment of the determination of approval or dis2 approval. If the determination disapproves such 

3 submission the Secretary shall include with 

4 such notification the specific reasons for the 

5 disapproval. 

6 ‘‘(C) FAILURE BY SECRETARY TO PROVIDE

7 NOTICE.—In the case of a failure by the Sec8 retary to mail or deliver the notice of the deter9 mination under subparagraph (B) by the last 

10 day of the period described in such subpara11 graph, the party involved may file an appeal di12 rectly to the administrative law judge within 30 

13 days after such failure. 

14 ‘‘(4) APPEALS.— 

15 ‘‘(A) IN GENERAL.—A party to a workers’ 

16 compensation settlement agreement that is dis17 satisfied with a determination under paragraph 

18 (3)(B), upon filing a request for reconsideration 

19 with the Secretary not later than 60 days after 

20 the date of notice of such determination, shall 

21 be entitled to— 

22 ‘‘(i) reconsideration of the determina23 tion by the Secretary (with respect to such 

24 determination); 


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1 ‘‘(ii) a hearing before an administra2 tive law judge thereon after such reconsid3 eration; and 

4 ‘‘(iii) judicial review of the Secretary’s 

5 final determination after such hearing. 

6 ‘‘(B) DEADLINES FOR DECISIONS.— 

7 ‘‘(i) RECONSIDERATIONS.— 

8 ‘‘(I) IN GENERAL.—The Sec9 retary shall conduct and conclude a 

10 reconsideration of a determination 

11 under subparagraph (A)(i) and mail 

12 or deliver electronically the notice of 

13 the decision of such reconsideration to 

14 the party involved by not later than 

15 the last day of the 30-day period be16 ginning on the date that a request for 

17 such reconsideration has been timely 

18 filed. 

19 ‘‘(II) APPEALS OF RECONSIDER20 ATIONS.—If a party to the workers’ 

21 compensation settlement involved is 

22 dissatisfied with the Secretary’s deci23 sion under subclause (I) that party 

24 may file an appeal within the 30-day 

25 period after the date of receipt of the 


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1 notice of the decision under such sub2 clause and request a hearing before 

3 an administrative law judge. 

4 ‘‘(III) FAILURE BY SECRETARY

5 TO PROVIDE NOTICE.—In the case of 

6 a failure by the Secretary to mail or 

7 deliver the notice of the decision 

8 under subclause (I) by the last day of 

9 the period described in such sub10 clause, the party involved may file an 

11 appeal directly to an administrative 

12 law judge not later than 30 days after 

13 such failure. 

14 ‘‘(ii) HEARINGS.— 

15 ‘‘(I) IN GENERAL.—An adminis16 trative law judge shall conduct and 

17 conclude a hearing on a decision of 

18 the Secretary or a determination with 

19 respect to which the Secretary failed 

20 to render a decision under paragraph 

21 (3)(B) or clause (i) and render a deci22 sion on such hearing by not later than 

23 the last day of the 90-day period be24 ginning on the date that a request for 

25 such hearing has been timely filed. 


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1 ‘‘(II) JUDICIAL REVIEW.—A deci2 sion under subclause (I) by an admin3 istrative law judge constitutes a final 

4 agency action and is subject to judi5 cial review. 

6 ‘‘(III) FAILURE BY ADMINISTRA7 TIVE LAW JUDGE TO RENDER TIMELY

8 DECISION.—In the case of a failure by 

9 an administrative law judge to render 

10 a decision under subclause (I) by the 

11 last day of the period described in 

12 such subclause, the party requesting 

13 the hearing shall be entitled to judi14 cial review of the decision under sub15 paragraph (A), notwithstanding any 

16 requirements for a hearing for pur17 poses of the party’s right to such judi18 cial review. 

19 ‘‘(5) ADMINISTRATION OF MEDICARE SET-ASIDE

20 PROVISIONS; PROTECTION FROM CERTAIN LIABIL21 ITY.— 

22 ‘‘(A) OPTIONAL DIRECT PAYMENT OF

23 MEDICARE SET-ASIDE AMOUNT.— 

24 ‘‘(i) ELECTION FOR DIRECT PAYMENT

25 OF MEDICARE SET-ASIDE.—Effective 30 


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1 days after the date of enactment of this 

2 subsection, with respect to a claim for 

3 which a workers’ compensation settlement 

4 agreement is or has been established, a 

5 claimant or workers’ compensation payer 

6 who is party to the agreement may elect, 

7 but is not required, to transfer to the Sec8 retary a direct payment of the qualified 

9 Medicare set-aside. With respect to a quali10 fied Medicare set-aside paid directly to the 

11 Secretary, the parties involved may cal12 culate the Medicare set-aside amount of 

13 such set-aside using any of the following 

14 methods: 

15 ‘‘(I) In the case of any Medicare 

16 set-aside of a compromise settlement 

17 agreement under paragraph (2)(C)(ii), 

18 the amount calculated in accordance 

19 with such paragraph. 

20 ‘‘(II) In the case of any Medicare 

21 set-aside, the amount based upon the 

22 payment amount for items and serv23 ices under the workers’ compensation 

24 fee schedule (effective as of the date 

25 of the agreement) applicable to the 


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1 workers’ compensation law or plan in2 volved, in accordance with paragraph 

3 (2)(C)(i)(I). 

4 ‘‘(III) In the case of any Medi5 care set-aside, the payment amount 

6 applicable to the items and services 

7 under this title as in effect on the ef8 fective date of the agreement. 

9 Such transfer shall be made only upon 

10 written consent of the other party to the 

11 agreement. 

12 ‘‘(ii) ELECTION SATISFYING LIABIL13 ITY.—An election made under clause (i), 

14 with respect to a qualified Medicare set15 aside shall satisfy any payment, in relation 

16 to the underlying claim of the related 

17 workers’ compensation settlement agree18 ment, required under subsection (b)(2) to 

19 be made by the claimant or payer to the 

20 Secretary. 

21 ‘‘(B) PROTECTION FROM CERTAIN LIABIL22 ITY.— 

23 ‘‘(i) LIABILITY FOR MEDICARE SET24 ASIDE PAYMENT GREATER THAN PAYMENT

25 UNDER WORKERS’ COMPENSATION LAW.— 


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1 No workers’ compensation claimant, work2 ers’ compensation payer, employer, admin3 istrator of the Medicare set-aside, legal 

4 representative of the claimant, payer, em5 ployer, or administrator, or any other 

6 party related to the claimant, payer, em7 ployer, or administrator shall be liable for 

8 any payment amount established under a 

9 Medicare set-aside for an item or service 

10 provided to the claimant that is greater 

11 than the payment amount for the item or 

12 service established under the workers’ com13 pensation fee schedule (or in the absence 

14 of such schedule, the medical reimburse15 ment rate) under the compensation law or 

16 plan of the jurisdiction where the agree17 ment will be effective. 

18 ‘‘(ii) LIABILITY FOR PROVIDER

19 CHARGES GREATER THAN PAYMENT

20 UNDER WORKERS’ COMPENSATION AGREE21 MENT.—With respect to a workers’ com22 pensation settlement agreement, a provider 

23 may not bill (or collect any amount from) 

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1 istrator of the Medicare set-aside, legal 

2 representative of the claimant, payer, em3 ployer, or administrator, or any other 

4 party related to the claimant, payer, em5 ployer, or administrator an amount for 

6 items and services provided to the claimant 

7 that is greater than the payment rate for 

8 such items and services established under 

9 the Medicare set-aside of the agreement. 

10 No person is liable for payment of any 

11 amounts billed for an item or service in 

12 violation of the previous sentence. If a pro13 vider willfully bills (or collects an amount) 

14 for such an item or service in violation of 

15 such sentence, the Secretary may apply 

16 sanctions against the provider in accord17 ance with section 1842(j)(2) in the same 

18 manner as such section applies with re19 spect to a physician. Paragraph (4) of sec20 tion 1842(j) shall apply under this clause 

21 in the same manner as such paragraph ap22 plies under such section. 

23 ‘‘(C) ELECTION OF PROFESSIONAL OR

24 BENEFICIARY SELF ADMINISTRATION OF MEDI25 CARE SET-ASIDE PAYMENTS.—Nothing in this 


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1 subsection or subsection (p) prohibits an indi2 vidual from electing to utilize professional ad3 ministration services or to self-administer pay4 ments of their Medicare Set-Aside in accord5 ance with existing law. 

6 ‘‘(6) TREATMENT OF STATE WORKERS’ COM7 PENSATION LAW.—For purposes of this subsection 

8 and subsection (p), if a workers’ compensation set9 tlement agreement is accepted, reviewed, approved, 

10 or otherwise finalized in accordance with the work11 ers’ compensation law of the jurisdiction in which 

12 such agreement will be effective, such acceptance, re13 view, approval, or other finalization shall be deemed 

14 final and conclusive as to any and all matters within 

15 the jurisdiction of the workers’ compensation law, 

16 including the determination of reasonableness of the 

17 settlement value; any allocations of settlement funds; 

18 the projection of future indemnity or medical bene19 fits that may be reasonably expected to be paid 

20 under the State workers’ compensation law; and, in 

21 the case of a compromise agreement, the total 

22 amount that could have been payable for a claim 

23 which is the subject of such agreement in accordance 

24 with paragraph (2)(C)(ii).’’. 


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1 (c) CONFORMING AMENDMENTS.—Subsection (b) of 

2 such section is further amended— 

3 (1) in paragraph (2)(B)(ii), by striking ‘‘para4 graph (9)’’ and inserting ‘‘paragraph (9) and sub5 sections (p) and (q)’’; 

6 (2) in paragraph (2)(B)(iii)— 

7 (A) in the first sentence, by striking ‘‘In 

8 order to recover payment’’ and inserting ‘‘Sub9 ject to subsection (q), in order to recover pay10 ment’’; and 

11 (B) in the third sentence, by striking ‘‘In 

12 addition’’ and inserting ‘‘Subject to subsection 

13 (q), in addition’’; and 

14 (3) in paragraph (3)(A), by striking ‘‘There is 

15 established a private cause of action’’ and inserting 

16 ‘‘Subject to subsection (q), there is established a pri17 vate cause of action’’. 

18 (d) MODERNIZING TERMINOLOGY FOR PURPOSES OF

19 MEDICARE SECONDARY PAYER PROVISIONS.—Subsection 

20 (b)(2)(A) of such section is amended by striking ‘‘work21 men’s compensation law or plan’’ and inserting ‘‘workers’ 

22 compensation law or plan’’ each place it appears. 

23 (e) LIMITATION ON LIABILITY.—The parties to a 

24 workers’ compensation settlement agreement which met 

25 the provisions of section 1862(b) of the Social Security 


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1 Act (42 U.S.C. 1395y(b)) on the effective date of settle2 ment shall be accepted as meeting the requirements of 

3 such section notwithstanding changes in law, regulations, 

4 or administrative interpretation of such provisions after 

5 the effective date of such settlement. 

6 (f) EFFECTIVE DATE.—The amendments made by 

7 this section, unless otherwise specifically specified, shall 

8 apply to a workers’ compensation settlement agreement 

9 with an effective date on or after October 1, 2015. 

Æ 


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