The PAID ACT (H.R. 1375/S. 1989)
Congress can help beneficiaries and settling parties resolve claims and drive better coordination of benefits if it requires CMS to share information with settling parties — specifically, whether the beneficiary is enrolled in the Medicare Advantage (MA) or Part D prescription drug plan. If CMS provides settling parties with the name of the plan and the dates of coverage, the settling parties will be able to resolve and repay MSP liabilities associated with settlements, judgments, or awards. CMS can provide this information in response to a “Section 111” query to provide settling parties with the necessary information of whether the beneficiaries has been, for the past three years, enrolled in an MA plan or Part D plan and identify the plan program.
To achieve a more efficient solution for beneficiaries, taxpayers, insurers, and employers, Congress should enact the bipartisan Provide Accurate Information Directly (PAID) Act (H.R. 1375/S. 1989). Passage of the PAID Act will allow settling parties to repay MSP amounts, and allow for the coordination of benefits, by requiring CMS to share the needed information. The PAID Act authorizes settling parties to receive the same information CMS provides to Group Health Plans today about MA and Part D plan enrollment information which leads to better coordination of benefits.
When a Medicare beneficiary is injured and another entity is required to pay for their healthcare expenses – such as in a tort case, workers compensation claim, or auto insurance payment – Congress has long recognized that Medicare’s responsibility to pay is “secondary.” This well-established Medicare Secondary Payer (MSP) policy is designed to ensure that the Medicare program does not waste taxpayer dollars by reimbursing healthcare expenses for which another entity is legally responsible. Today, however, the process by which CMS and private Medicare plans recapture payment for claims that were not its responsibility to pay is broken. Specifically, the failure of CMS to share data has lead to inappropriate coverage denials for beneficiaries, costly, but mandatory pursuit of miniscule recoveries, and a paralyzing uncertainty for parties to medical liability settlements.