Brace for Changes to the MSA and Section 111 Process

The Medicare compliance industry continues to brace for changes to the MSA and Section 111 process based upon Notice of Proposed Rulemaking issued by CMS in 2018.  Many questions continue to loom regarding this process and particularly how the claimant and defendants will be protected if these rules are implemented.

With various industry studies and trends demonstrating that MSA allocations submitted to CMS have continued to increase in price, one of the most important elements of the MSA process is, and remains, the voluntary nature of MSA submissions.   Thousands of MSAs are never submitted to CMS for approval not only because this is a voluntary process, but also based upon CMS’ own review threshold guidelines. The parties are still required to protect Medicare’s interest, whether an MSA is submitted to CMS or not, but the way in which Medicare’s and the parties’ interests are protected can be vastly different depending on who is preparing the MSA.

Ensuring that the MSA allocation is reasonable is the first step in this process.  Utilizing prescribing doctor recommendations; claimant’s pharmacy and medical utilization history; and approaching the case from an evidence-based medicine approach is part of the protections that ensure reasonable allocations.  Transparency in this process is also important and includes following CMS guidelines for the administration and reporting of the MSA funds.

Post-settlement assistance offers continued protection to the claimant, defendants, and CMS.  Once the claim is submitted and approved by CMS, the claimant is on his or her own to manage the MSA funds unless the MSA is professionally administered.  Even if the case is not submitted to CMS for review, the claimant may still be in this same predicament.  Providing support for the claimant during the post-settlement MSA process is key to the claimant’s success in what can be a very confusing journey.  This helps prevent the MSA funds from being prematurely exhausted or improperly expended.

Even with potential new rules approaching, what should remain consistent are the protections the parties should be afforded throughout the MSA process.  From the allocation to post-settlement assistance, NuQuest provides a comprehensive approach to Medicare compliance.  For further information on this or any of your Medicare compliance needs, please contact NuQuest.