Source: https://www.medicareadvocacy.org/limits-on-medicares-recovery-health-care-payments-when-the-beneficiary-has-liabaility-or-workers-compensation-insurance-2/
Timestamp: 2019-04-23 10:48:08+00:00

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The Medicare Secondary Payer (MSP) law was enacted by Congress to assure that Medicare does not pay for medical expenses that could be covered by private insurance. When beneficiaries are injured, Medicare will pay for care related to the injury if payment by these private insurances cannot be expected promptly, but it expects to recover its costs when the insurance claim is resolved. MSP requirements apply to Medicare beneficiaries with Workers' Compensation and to those with liability insurance, but the application of the law by the Centers for Medicare and Medicaid Services (CMS) differs significantly in these two situations. Check out your My Insurance Guide online to see what you qualify for.
In Workers' Compensation (WC) cases where there is a lump sum payment of the WC benefit, the MSP law has also been implemented to preclude Medicare payment for future medical expenses as well as past expenses related to the injury until the amount of the payment has been expended on relevant future medical expenses. However, the MSP regulations address insurance payment for future medical expenses only with respect to WC insurance.  Although they make provision for reimbursement of Medicare for past injury-related medical expenses out of liability payments, the regulations are silent as to payment for future medical expenses in the liability situation.
Preclusion of future Medicare payments in some WC cases by designating an anticipated amount for accident related medical expenses is facilitated by creation of Medicare Set-Aside Arrangements. Neither the Medicare statute nor regulations discuss CMS approval of settlements or Medicare Set Aside Arrangements as a means to assure that a beneficiary's future medical expenses will be paid from Workmen's Compensation or liability insurance proceeds.
CMS policy guidance is the main source of practice information about how the agency has implemented its MSP statutory responsibility. It is primarily found in the CMS manuals, which are normally given deference if they are persuasive, but unlike the statute and regulations, do not have the authority of binding law. CMS also posts informal advice concerning Medicare on its website, but such postings have no legal authority.
In contrast to WC cases, Medicare does not look to the proceeds of liability cases for payment of medical expenses incurred after resolution of the claim. Presently there is a good deal of speculation about the possible extension of MSP requirements to deny payment for future injury-related expenses in liability cases. If this were to occur, it could expand the use of Medicare Set-Aside Arrangements from WC cases into the larger area of liability cases. However, considerable changes in Medicare law and policy would be necessary before such an extension could occur.
As noted above, there is no discussion in the existing Medicare regulations of future medical expenses in liability cases, unlike the regulations concerning MSP requirements in WC cases. Nor does the MSP Manual contain any requirements for payment of beneficiaries' future medical expenses in liability cases. In fact, the manual states, "There should be no recovery of benefits paid for services rendered after the date of a liability insurance settlement."  As would be expected given the lack of Medicare interest in denying payment for future medical expenses in liability situations, the MSP Manual also contains no discussion of the use of Medicare Set-Aside Arrangements in these cases.
 S.S.A. § 1862(b)(2), at 42 U.S.C. § 1395y(b)(2).
 S.S.A. § 1862(b)(2)(B)(ii), at 42 U.S.C. § 1395y(b)(2)(B)(ii).
 Id., Chap. 7, § 40.3.4.
 MSP Manual, Chap. 7, § 40.3.5.
 MSP Manual, Chapter 7, § 50.5.
 Barbara Wright, CMS Acting Director of Medicare Debt Management, March 24, 2009.
 CMS Alert, February 23, 2009.

References: § 1862
 § 1395
 § 1862
 § 1395
 § 40
 § 40
 § 50