I 
110TH CONGRESS 
1ST SESSION H. R. 2549 
To amend section 1862 of the Social Security Act with respect to the applica-
tion of Medicare secondary payer rules to workers’ compensation settle-
ment agreements and Medicare set-asides under such agreements. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 24, 2007 
Mr. TANNER (for himself, Mr. ENGLISH of Pennsylvania, Mr. VAN HOLLEN, 
and Mr. REYNOLDS) introduced the following bill; which was referred to 
the Committee on Ways and Means, and in addition to the Committee 
on Energy and Commerce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
A BILL 
To amend section 1862 of the Social Security Act with 
respect to the application of Medicare secondary payer 
rules to workers’ compensation settlement agreements 
and Medicare set-asides under such agreements. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Secondary 
Payer and Workers’ Compensation Settlement Agree-
ments Act of 2007’’. 
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SEC. 2. APPLICATION OF MEDICARE SECONDARY PAYER 
RULES TO CERTAIN WORKERS’ COMPENSA-
TION 
SETTLEMENT 
AGREEMENTS 
AND 
QUALIFIED 
MEDICARE 
SET-ASIDE 
PROVI-
SIONS. 
(a) EXCEPTION FROM SECONDARY PAYER PROVI-
SIONS FOR CERTAIN WORKERS’ COMPENSATION SETTLE-
MENT AGREEMENTS.—Section 1862 of the Social Security 
Act (42 U.S.C. 1395y) is amended— 
(1) in subsection (b)(2)(A)(ii), by inserting 
‘‘subject to subsection (l),’’ after ‘‘(ii)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(l) EXCEPTION FROM SECONDARY PAYER PROVI-
SIONS FOR CERTAIN WORKERS’ COMPENSATION SETTLE-
MENT AGREEMENTS.— 
‘‘(1) IN GENERAL.—A workers’ compensation 
law or plan shall not be treated, for purposes of sub-
section (b), as a primary plan with respect to an ex-
empt workers’ compensation settlement agreement. 
‘‘(2) EXEMPT WORKERS’ COMPENSATION SET-
TLEMENT AGREEMENT DEFINED.—For purposes of 
this subsection, an ‘exempt workers’ compensation 
settlement agreement’ means a workers’ compensa-
tion agreement that is described in any of the fol-
lowing subparagraphs: 
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‘‘(A) PRESENT
VALUE
OF
LESS
THAN 
$250,000.—A workers’ compensation settlement 
agreement that has a present value, as deter-
mined under paragraph (3)(A), that is less than 
the greater of the following: 
‘‘(i) $250,000. 
‘‘(ii) The product (as published under 
paragraph (3)(B)) of $250,000 and the 
ratio of— 
‘‘(I) the national average wage 
index (as defined in section 209(k)(1) 
of the Social Security Act) for the cal-
endar year before the calendar year in 
which the workers’ compensation set-
tlement agreement became effective, 
to 
‘‘(II) the national average wage 
index for 2005, 
with such product, if not a multiple of 
$1,000, being rounded to the next higher 
multiple of $1,000. 
‘‘(B) COMPROMISE AGREEMENT.—A work-
ers’ compensation settlement agreement that is 
a compromise agreement (as defined in para-
graph (5)) that has a present value that is not 
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more than 20 percent of the present value of 
the total amount that could have been payable 
under the applicable workers’ compensation law 
or similar plan if the claim involved had not 
been subject to a compromise agreement. 
‘‘(C) LIKELY INELIGIBILITY OF WORKERS’ 
COMPENSATION CLAIMANT FOR MEDICARE BEN-
EFITS.—A workers’ compensation settlement 
agreement the claimant of which is not eligible 
for benefits under this title as of the effective 
date of the agreement and, under paragraph 
(4), is unlikely to become so eligible within 30 
months after such effective date. 
‘‘(D) NO FUTURE MEDICAL EXPENSES.—A 
workers’ compensation settlement agreement 
the claimant of which is not eligible for pay-
ment of medical expenses incurred after the ef-
fective date of such agreement that are avail-
able under the workers’ compensation law or 
plan of the jurisdiction in which such agree-
ment will be effective. 
‘‘(E) NO LIMITATION ON FUTURE MEDICAL 
EXPENSES.—A workers’ compensation settle-
ment agreement that does not limit or extin-
guish the right of the claimant involved to pay-
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