How well are States complying with Medicaid’s third-party liability requirements?

Medicaid is a joint federal-state program that provides health coverage to millions of low-income Americans. However, Medicaid is not supposed to pay for services that are covered by other sources, such as private insurance, Medicare, or workers’ compensation. This is known as the third-party liability (TPL) requirement, which ensures that Medicaid functions as the payer […]

CMS Releases New Workers Compensation Set Aside Arrangements Guide.

The new WCMSA has been released.

Medicare Secondary Payer (MSP) NGHP Reporting Entities CMS Update Alert

CMS: NGHP Responsible Reporting Entities (RREs) that both Med Pay andPersonal Injury Protection (PIP) coverage should be included when reporting the No-Fault Insurance Limit (Field 61 of Claim Input File). As such, NGHP RREs must combine both Med Pay and PIP coverage limits for a policy when they are separate coverages being paid out on […]

CMS finalizes Workers Comp Set aside regulations

CMS has issued new regulations regarding Medicare Workers Compensation Set Asides, while these do not as yet apply to Liability settlements, they are informative. See Version 3.1 of the WCMSA Reference Guide has been posted to the Downloads section of the Workers’ Compensation Medicare Set Aside Arrangements page on Refer to Section 1.1 for a summary of updates.

Medicaid TPL Rights Postponed

In 2006 the United States Supreme Court decided Ahlborn v. Arkansas 547 U.S. 268 (2006). There, the Court in interpreting Medicaid’s long standing statutory rights of recovery held that from an unallocated third party settlements, Medicaid was only entitled to recover that portion of  an unallocated settlement that represented past medicals.  Thus extinguishing Medicaid’s long standing, […]

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