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AAJ Response on Passage of SMART Act

President Obama recently signed a bill into law known as the SMART Act–Strengthening Medicare and Repaying Taxpayers Act. The passage of the measure was a bipartisan effort with Republicans and Democrats in both the Senate and House supporting the bill. That sort of joint effort to pass common sense legislation is rare in today’s toxic political environment.

What It Does
In general, the SMART Act is intended to make some changes to rules so that program participants receive the help they need in a quick fashion and to guarantee that taxpayers receive reimbursements when necessary for the cost of that care. These goals are met by streamlining the “Medicare Secondary Payer” system (MSP). The MSP is the system that seeks reimbursement to the Centers for Medicare and Medicaid Services (CMS) when those medical payments are the responsibility of a third party.

For example, if someone is involved in an accident that sends them to the hospital or nursing home, the costs may be borne initially by the Medicare or Medicaid program if the injured party is covered. However, what if the accident was caused by someone else acting negligently? That negligent party–perhaps a distracted driver–may eventually be found legally responsible and forced to pay for the consequences of that injury. If the driver (or their insurance company) pays for the harm–including medical bills–there needs to be a process in place so that taxpayers are refunded. However, it is critical that these issues be handled delicately, so that the injured party not suffer undue delay or hardship as a result of handling these matters

Fixing the Problem
Part of the problem in the past was that those who received judgments following negligence were unable to access their damage award in a timely fashion. That is because the current MSP system was plagued with inefficiency and confusion. The damage award was not paid out until Medicare was entirely repaid. But it could take a significant length of time–even years–for the Medicare system to report the reimbursement amounts. That delay causes significant harm to individuals and their families trying to get their lives back together after an accident. Making matters worse, sometimes CMS makes multiple reimbursement requests, further delaying the situation.

The SMART Act seeks to change that. For one thing, it requires CMS to maintain a website that allows easy access to information about claims and reimbursements. Under the law CMS is required to upload disbursements within 15 days with necessary information provided about those payments.

The new law fleshes out some other details as well. It includes requirements upon Medicare beneficiaries to provide CMS with information about possible settlements, and an appeals process is created to handle disputes between the parties if they arise. A time limit is created (3 years) so that CMS cannot delay the process indefinitely. In addition, a threshold is set up so that CMS cannot claim recovery amounts greatly in excess of the average claim.

All told, our Chicago nursing home attorneys appreciate that the spirit of this bill is a good one. Hopefully CMS will work quickly to make the necessary changes to conform with these requirements and no more families will be forced to deal with the damaging and stressful delays that come with working with CMS on these secondary payer issues.

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