Tuesday, April 24, 2012

H.R. 1063: What the Feds Can Do to Help Work Comp

I heard some discussion at RIMS around House Resolution 1063, titled "Strengthening Medicare And Repaying Taxpayers Act" (or the SMART Act, because all federal legislation must inevitably lead to a catchy acronym).  The bill is suprisingly brief (13 pages), relatively straightforward, and seems to create a much more efficient approach to protecting Medicare's interests in light of work comp settlements.

Whenever I'm with a client and we're discussing prescription drug over-utilization, I typically see a lot of nodding heads and sympathetic glances.  But when the issue of MSAs comes up (which, when discussing the onslaught of drugs in work comp, almost always comes up), claims executives' faces become contorted - total anguish.  The process is viewed as difficult, unreliable, unpredictable, and intractable.  I'm no expert on MSAs, but federal legislation to simplify the process seems to make sense (by the way, even though I'm not an expert, PRIUM has partnered with experts in the field - if you need one, let me know). 

The core of the bill appears to be found in Section II: "Not later than 65 days after the date of receipt of a request under subclause I, the Secretary shall respond to such request with a statement of reiumbursement amount, which shall constitute the conditional payment subject to clause (ii) related to such settlement, judgment, award or other payment."

So... assuming the claim is on a rational, evidence-based clinical path (big assumption, I know), this bill aims to create a more predictable timeline for CMS response and could lead to greater efficiencies in closing out claims.

A link to the entire bill is here.

What says the MSA community?  Helpful? 

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