Updates from Sacramento, Washington, and Grassroots Outreach
New guidelines from Medicare
and Medicaid for calculating conditional payments Self-calculating guidelines for claims with settlement value of $25,000 or less
AAJ has worked determinedly for two years to improve the
Medicare Secondary Payer (MSP) reimbursement process. Now a bright spot in an otherwise dismal year in Washington has emerged: Improved Conditional Payment Guidelines from the Centers for Medicare & Medicaid Services. The Centers for Medicare & Medicaid Services (CMS) have
released guidelines to provide certainty and finality when it comes to conditional payments. These guidelines – which will initially be imple- mented in claims with a total settlement value of $25,000 or less – will enable you to receive a final number from CMS about how much is owed prior to settlement. • The parties can self-calculate how much they believe they owe CMS and provide CMS with that number. • CMS will review this information and determine its accuracy. • CMS will then provide a final demand letter within 60 days of a request by the beneficiary or his or her attorney. • The final demand from CMS will be considered reliable and final if settlement occurs within 60 days of the date the final demand letter is issued. • Full instructions on how to calculate the amount of Medicare’s con- ditional payment were scheduled to be available at
www.msprc.info by January 15. The option of obtaining a conditional payment amount will be available in February 2012 for certain settlements involving physi- cal trauma-based injuries where treatment has been completed. Criteria for using this option includes: • The settlement does not relate to ingestion, exposure, or med-
ical implant; • The incident occurred at least six months before the benefici-
ary submits his proposed conditional payment amount to Medicare; • The beneficiary demonstrates that treatment has been complet-
ed and no further treatment is expected either through a written physi- cian attestation or by certifying in writing that no medical treatment related to the case has occurred for at least 90 days prior to submit- ting the proposed conditional payment amount to Medicare. • The claim amount of $25,000 is considered a starting point. CMS stated that the claim amount will increase. We expect the next phase-in in approximately six months. You rallied around this enormous effort and supported AAJ Public
Affairs as we worked with the Obama administration to clarify trial lawyers’ concerns. Additionally, AAJ worked through a bipartisan coalition of business and insurance groups to raise the profile of this issue, and so many of you communicated directly to your members of Congress to amass co-sponsors for MSP-related legislation.
88 — The Advocate Magazine FEBRUARY 2012
Sacramento update: 2012 elections Whether we are ready for it or not, the 2012 election season is
upon us. The course of our state and country depends in large meas- ure upon what happens next June and November in elections. In our own back yard, we watch as devastating cuts to education and courts undermine our future. Against this backdrop we look at what part we can play in shaping future events, preserving what is good and moving forward to make things better. As trial attorneys, all of us know we must contribute our fair
share if we are to stop the bleeding in this state. We have to do our part by supporting the governor in placing fair revenue solutions before voters so that the state has needed revenue to arrest further cuts to essential government functions, including our courts. We must do our fair share to elect public officials who have the courage to fight for the civil justice system and are willing to take on Wall Street and Corporate America. And we do our part in court to protect people from wrongdoers eager to avoid accountability. Our aggressive legislative and political campaign demands that
you also do your fair share through CAOC to support our collective efforts. How do we assess what is fair? We look at past giving history for each of our members and supporters. We look at how that giving compares to others in the community. And we look at capacity and stature in the community. Giving political money is a drain on our per- sonal checkbooks. But one thing we know is that if we do not do our fair share, no one else will fight for consumers. This is our shared burden – and our blessing in a land where all too often we take our freedoms for granted.
Grassroots outreach Talking directly to legislators in their districts about the civil jus-
tice system is an effective way to influence the legislative process. In cooperation with Consumer Attorneys of California (CAOC), our local legislator liaisons are in each district to personally deliver our mes- sage. The efforts of our liaisons greatly support the work of our CAOC advocates in Sacramento. In 2011, CAALA members made 24 local visits to legislators in
the Los Angeles area. In 2012, liaisons will again be making district visits to legislators. For information on consumer attorneys’ local outreach to legislators or to volunteer for meeting with a specific legislator, contact Mark Wirth at
markwirth@aol.com or (909) 794-7091. Check out our Government Relations Bulletin Web site at
caalagovernmentrelations.com.
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