Future Medicals in Liability Cases: Notice of Proposed Rulemaking on the Horizon



There’s now word that the Centers for Medicare & Medicaid Services (CMS) will issue a Notice of Proposed Rulemaking as soon as September 2013 on addressing future medical costs in liability cases. The U.S. Department of Health & Human Services (HHS) has issued an agenda item indicating that is the earliest that CMS could proceed with issuing parameters for funding Medicare beneficiaries’ future medical expenses in liability claims.

The Notice of Proposed Rulemaking is expected to outline how Medicare’s interest should be protected (per the Medicare Secondary Payer Act [42 U.S.C. §1395y(b)(2)]) in cases where future medical care is claimed or effectively released in the settlement, judgment, award, or other payment of damages. While CMS has guidelines in place for the handling of future medical expenses in workers’ compensation cases, until final rules are released in the liability context, there are no similar standards for claims involving self-insureds and automobile, liability, and no fault coverage.

CMS began the process of issuing those regulations last year, when it released an Advanced Notice of Proposed Rulemaking (ANPRM) for these claims in June 2012. This agenda item now reveals that CMS intends to take the next step.

The upcoming guidelines are expected to pinpoint the circumstances in which a special account needs to be established – or dollars set aside – for Medicare’s funding of future medical treatment stemming from an injury for which a Medicare beneficiary received a settlement or damage award. These accounts are known as Medicare Set Asides (MSAs).

The Garretson Resolution Group’s team of experts will update you on significant milestones as future cost of care regulations are developed. For more information, please visit our website or call John Cattie at (866) 694-4446 (jcattie@garretsongroup.com).

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