Superior Court of New Jersey Allows Plaintiff Attorney’s Fees to be Deducted from MSA Allocation

There has been a great deal of commentary from the liability industry concerning the necessity of liability Medicare Set-Aside (MSA) allocations under the Medicare Secondary Payer Act (MSP), and whether the published guidance applicable for workers’ compensation MSAs  provides any insight regarding how liability MSAs should be handled. Although there is no statutory requirement to create an MSA when future medical expenses are awarded, it is recommended by the Centers for Medicare and Medicaid Services (CMS) and has become a best practice in workers’ compensation cases. In liability cases, resistance to MSAs continues due to a lack of published guidance and issues that are specific to liability cases. For example, if a settlement is only $100,000, and the projected MSA is $150,000, how can plaintiff’s attorneys get their fees if the entire settlement is taken up by an MSA?

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CMS Approval of MSA Allocations

A finalized settlement that includes a Medicare Set-Aside (MSA) where the parties have not yet obtained approval from the Centers for Medicare & Medicaid Services (CMS) can cause misunderstandings and complications, particularly on the part of claimants who are anxious to receive their settlement funds and may not understand the wait time associated with receiving CMS approval of the MSA. This was the issue that arose in Harrelson v. Arcadia, NO.2010 CA 1647, Court of Appeals of Louisiana, First Circuit. 

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CMS Issues TIN Reference Response File and Address Validation Alert

On May 17, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a revised alert providing information pertaining to Non-Group Health Plans (NGHP), classified as Responsible Reporting Entities (RREs) under Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA).

The revised alert provided RREs the following additional information regarding revisions being made to validation of tax identification numbers (TINs) and related name and address information effective October 1, 2011.

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MSPRC Releases New Version of Rights and Responsibilities Letter

PMSI has been informed that the MSPRC has released a new version of the Rights and Responsibilities (RAR) letter on June 10, 2011. A copy of the revised RAR is available on the MSPRC website.    PMSI has noted that the most significant change to the RAR letter is the addition of language to the section … Read moreMSPRC Releases New Version of Rights and Responsibilities Letter