On August 2, 2019, Representatives Mike Thomson (D-CA) and George Holding (R-NC) introduced legislation aimed at reforming the Centers for Medicare and Medicaid Services’ (CMS) Workers’ Compensation Medicare Set-Aside (WCMSA) process. Introduced as H.R. 4161, this bill is now known as the Coordination of Medicare Payments and Workers’ Compensation Act (COMP Act). This proposed legislation seeks to make additions and amendments to 42 U.S.C. 1395y(b)(2)(A)(ii).
The proposed COMP Act shares similar features to prior proposals that failed to gain traction. In general, the COMP Act seeks to establish a statutory framework for various aspects of the WCMSA process, including codifying certain aspects of allocating, and approving and satisfying WCMSA obligations. Currently, WCMSA review policies are governed by CMS’ WCMSA Reference guide, and CMS has an established voluntary and optional WCMSA review and approval process. Of note, unlike the prior bills, the COMP Act does not contain any monetary thresholds below which MSAs or conditional payment reimbursement would be exempt.
Key proposals contained in the COMP Act include:
- Providing specific legal definitions to key concepts related to the WCMSA process, including the term Medicare set-aside and compromise settlement;
- Outlining circumstances where a WCMSA would satisfy obligations under the Medicare Secondary Payer (MSP) statute;
- Allowing for proportional adjustment of the total WCMSA amount regarding compromise settlement agreements related to denied, disputed or contested claims;
- An optional WCMSA approval process requiring CMS to provide notice of approval or disapproval within 60 days, and allowing parties to challenge CMS determinations via administrative appeal;
- An option for direct deposit of the WCMSA fund to Medicare upon the agreement of both parties; and
- Greater recognition of state and jurisdictional workers’ compensation laws.
Going forward, we will need to monitor the COMP Act to see if it gets referred to any Congressional committee(s) for further study and possible mark-up. The bill also awaits a Congressional Budget Office (CBO) score. Prior similar legislation died at the committee stage without a vote. To date, the bill has not been introduced in the U.S. Senate.
ISO Claims Partners is monitoring this development and will provide future updates as warranted. In the interim, please contact the author if you have any questions.