Twin pieces of legislation (SB1514 and HR2649) submitted to Congress would create an appeals process for Medicare set-asides and impose a set of standards to achieve more consistency in the amounts of individual set-asides. According to a release from the American Insurance Association (AIA) in praise of the bill, the measure would:
- Establish clear criteria in the determination of the settlements that are qualified for acceptance and that may be submitted for review;
- Create certainty for calculating the amounts to be included in set-asides;
- Provide a reasonable time frame in which CMS is to review set-aside submissions;
- Provide an appeals process for parties to CMS determinations that would make them binding;
- Provide an optional direct payment of set-aside amounts to Medicare;
- Assure that settlements that meet the terms of federal statute at the time of settlement are not disapproved based on later changes in law, regulations or administrative interpretations.
The bipartisan legislation, if passed, is expected to reduce overall costs in the MSA system for both CMS and external stakeholders. It is very similar to bills directed at the same problem in sessions past.