Today NAMSAP LMSA Committee co-chair, Tom Stanley, released a special advisory bulletin about Liability Medicare Set Asides (LMSAs). The bulletin is a recap of the meeting between members of NAMSAP and The Centers for Medicare and Medicaid Services (CMS) on April 16, 2018. The discussion included review workload thresholds and an estimated time frame for rolling out the program.
While this information is subject to change, we wanted to compare the information released around LMSAs to what we currently see in the WCMSA process.
How does this compare to the WCMSA Review Process?
How is the LMSA Review Process Expected To Be Similar?
- The submission process will be voluntary, as it is with WCMSAs
- Eligibility remains the same, meaning Medicare beneficiaries or injured parties who have reasonable expectation of Medicare eligibility within 30 months. All parties must have Medicare’s best interest in mind.
- CMS will publish a LMSA reference guide, similar to the WCMSA Reference Guide
- The enforcement mechanism from CMS is the denial of services, just as it is in Worker’s Comp
What Differences Can We Anticipate
- A settlement must first be reached in order for CMS to being review a LMSA
- Where the threshold for Medicare beneficiaries for WCMSAs is $25,000, the anticipated workload threshold for LMSAs is $250,000.
- For settlements between $250,000-$750,000 CMS stated they will apply a formula to determine the final LMSA amount. The total settlement amount would be calculated by the subtraction of certain expenses and the application of the discount(s). Currently there’s no information available on how the formula will be structured.
- A settlement above $750,000 is a full commutation, meaning it would be treated the same as workers comp involving a traditional MSA, the only difference is being submitted after settlement
CMS expects an 18 month timeline from April 2018 to roll out the program. Previously it was expected that CMS would release information surrounding a LMSA review process in October 2017.
For more information, NAMSAP will be hosting a session at the Annual Conference and is possibly hosting a Webinar.
Check out our timeline on LMSAs up until this point.