Defending Employers

Episode 222: Impact of Center for Medicare & Medicaid Service's New Set-Aside Submission Reference Guide on Workers' Compensation Settlements

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This episode addresses the January 10, 2022 changes to the Center for Medicare & Medicaid Service’s Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide, Version 3.5 and applies to all jurisdictions where “full-and-final” settlements (including future medical exposure) are allowed.

The Set Aside Reference Guide was updated on January 10, 2022 to state that Medicare no longer gives “non submit” set aside allocations the same deference as “submitted and approved” set aside allocations. This will have a big impact on workers’ compensation settlements. This is new and conflicts with other guidance issued by the Center for Medicare & Medicaid Service regarding both required pre-approval and the review thresholds.

We explain and discuss the following:
  • What the carriers/self-insured obligations are under the Medicare as Secondary payer Act (the “Act”).
  • The options available to carriers and self-insured who want to remain in compliance with the Act.
  • The costs and tradeoffs between the various options for remaining in compliance with the Medicare as Secondary Payer Act.
  • The legal precedence and authority that CMS has and explains the litigation risks of various methods of compliance.
  • The contradictions inherent in the new Reference Guide which makes compliance with the new guidance impossible in some situations.

    • This audio is from a live webinar provided to clients on January 19, 2022.

    How to attend these webinars live and ask questions

    Join us for our monthly webinars on New York and New Jersey workers’ compensation law.

    • Register for a New York Workers' Compensation Webinar
    • Register for a New Jersey Workers' Compensation Webinar
      • Schedules and Information

      Handout materials are provided in advance of each session. The webinar courses follow the "life cycle" of a claim and correspond to chapters in the Workers' Compensation Handbooks offered by the Firm.

      Disclaimer

      This webinar is not legal advice! The materials presented by this webinar/podcast and any affiliated website are for informational purposes only and are not offered as legal advice as to any particular matter. No viewer/listener/reader should act on the basis of these materials without seeking appropriate professional advice as to the particular facts and applicable law involved. The materials are not represented to be correct, complete, or up-to-date. Opinions presented by this video/podcast are the opinions of the author.

      Neither the use of this web site nor the transfer of information to or from this web site shall create or constitute an attorney-client relationship between Greg Lois, the presenter in the video/podcast, or LOIS LAW FIRM LLC and any person. You should not send any confidential information to this web site until after you have entered into a written agreement for the performance of legal services.

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