Bill > S2731

This bill amends Title XVIII of the Social Security Act to clarify how Medicare's secondary payer rules apply to workers' compensation settlement agreements, particularly concerning "qualified Medicare set-aside" (QMSAs) provisions. The Medicare secondary payer rule generally means that Medicare should not pay for medical expenses if another payer, like workers' compensation, is responsible. This bill establishes specific conditions under which a workers' compensation settlement agreement will not be treated as a primary payer, including if the total settlement amount is $25,000 or less, if the claimant is unlikely to become eligible for Medicare within 30 months, or if there are no future workers' compensation medical expenses. It also outlines how a QMSA, which is a provision in a settlement agreement that sets aside funds for future medical care related to the workers' compensation claim, can satisfy Medicare's secondary payer obligations. The bill details the requirements for a QMSA to be considered "qualified," including how the set-aside amount should be calculated, and provides a process for optional prior approval of QMSAs by the Secretary of Health and Human Services, along with appeal rights. Importantly, it aims to protect parties from certain liabilities related to Medicare set-aside payments and clarifies that providers cannot bill claimants more than the amount established by the Medicare set-aside. These changes are intended to modernize terminology and provide clearer guidance for applying Medicare secondary payer rules to workers' compensation settlements, with an effective date generally applying to agreements on or after October 1, 2015.