Casualty Solutions

10/18/2019 - 3 min read

CMS releases WCMSA Self-Administration Toolkit 1.3

CMS has released the latest edition of its Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (Version 1.3; October 10, 2019).

10/11/2019 - 8 min read

Ninth Circuit: CIGA is not a “primary payer” under the MSP and does not have to reimburse Medicare

In a significant new case out of California, the United States Circuit Court of Appeals (Ninth Circuit)[1] in California Insurance Guarantee Association (CIGA) v. Azar, 2019 WL 5076945 (9th Cir. Oct. 10, 2019) reversed the United States District Court for the Central District Court of California [2] and ruled that CIGA is not a “primary plan” under the Medicare Secondary Payer (MSP) statute and, therefore, not liable to reimburse Medicare conditional payments made on behalf of workers’ compensation claimants.

10/10/2019 - 3 min read

CMS releases WCMSA Portal User Guide Version 5.9

On 10/7/19, CMS released the latest edition of its Workers’ Compensation Medicare Set-Aside Portal User Guide (WCMSAP) (Version 5.9).

Linkedin Sales Navigator H5cptwuvhm Unsplash

10/3/2019 - 9 min read

South Carolina court: Medicare Advantage Plan can sue for “double damages” under the Medicare Secondary Payer statute

The South Carolina District Court is the latest jurisdiction presented with the question of whether a Medicare Advantage Plan (MAP) can sue for “double damages” under the Medicare Secondary Payer’s (MSP’s) private cause of action (PCA) statute.

9/13/2019 - 9 min read

The new indemnity data call – are you ready?

The NCCI new indemnity data call initiative is scheduled to launch in Q2 of 2020, with the certification and testing process slated to begin in Q1 of 2020.

8/21/2019 - 6 min read

Seventh Circuit bypasses Medicare Advantage “double damages” question

The Seventh Circuit affirmed (with modification) a ruling from the U.S. District Court for the Central District of Illinois dismissing a MAP assignee’s PCA claim on standing grounds.

8/12/2019 - 2 min read

Release of proposed “future medicals” rules will be delayed

CMS’s release of proposed rules to address “future medicals” in relation to non-group health plan settlements will be delayed from Sept. 2019 to Oct. 2019.

8/1/2019 - 3 min read

WCMSA RX update – FDA approves first generics of Lyrica

On 7/22/19, the FDA announced it approved the first generics of Lyrica. This comes at a critical time as CMS has increasingly been including Lyrica in WCMSAs

7/26/2019 - 9 min read

Massachusetts court: Medicare Advantage Plan’s assignee can sue for “double damages” under the MSP

Massachusetts is the latest jurisdiction to take a favorable view of MAPs possessing private cause of action rights under the Medicare Secondary Payer.

Jubal Kenneth Bernal Uvdhvgaeem4 Unsplash

7/15/2019 - 1 min read

CMS releases new NGHP Section 111 user guide (Version 5.6)

On 7/1/19, CMS released an updated Section 111 User Guide (Version 5.6) regarding non-group health plans (liability, no-fault and workers’ compensation).

7/11/2019 - 2 min read

PAID Act introduced in the U.S. Senate

On June 26, 2019, Senators Tim Scott (R-SC) and Ben Cardin (D-MD) introduced Senate Bill 1989 into the U.S. Senate.

7/8/2019 - 8 min read

Medicaid expansion makes recovery efforts more urgent

Within broad federal requirements, states and territories have significant flexibility in program design and administration, resulting in 56 unique Medicaid programs.

6/27/2019 - 4 min read

Think about your thresholds: Preventing errors to avoid CMS penalties

One way responsible reporting entities can attempt to achieve full CMS compliance and avoid potential penalties is to closely consider file thresholds.

Beatriz Perez Moya Xn4t2pvuugk Unsplash 1

6/17/2019 - 6 min read

Big reforms are coming to Michigan PIP - How the changes will impact Medicare Secondary Payer compliance

On 5/30/19, Governor Gretchen Whitmer signed Michigan Senate Bill 1, which makes significant changes to Michigan’s personal injury protection (PIP) system.

6/17/2019 - 8 min read

Florida court: No-fault pre-suit notice requirement must be followed before Medicare private cause of action claim can proceed

In a new Florida decision, the U.S. District Court in ruled Florida’s no-fault pre-suit notice requirement must be satisfied before a PCA action can proceed.