The Medicare Advocacy Recovery Coalition (MARC) has announced that the Provide Accurate Information Directly (PAID) Act was introduced yesterday, February 27, 2019 in the U.S. House of Representatives as H.R. 1375 by lead Co-Sponsors Reps. Ron Kind (D-WI) and Gus Bilirakis (R-FL). Representatives Kind and Bilirakis have sponsored this bipartisan legislation to improve the Medicare Secondary Payer Act (MSP).
PAID’s Purpose: To require the Centers for Medicare & Medicaid Services (CMS) to return beneficiary enrollment information in Part C/Medicare Advantage and/or Part D plans to Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs). Currently, when an NGHP RRE queries an injured party’s Medicare status to determine whether MMSEA Section 111 Reporting is required, CMS solely returns enrollment information regarding Traditional Medicare Parts A and B.
The problem with this is that a primary payer does not have knowledge of whether a Medicare Advantage or Part D plan has made payments related to the injury in which it would assert a conditional payment recovery. Often, a Medicare Advantage or Part D plan will assert a lien post-settlement, or if not reimbursed, the Medicare Advantage Plan will file a lawsuit in which recovery is asserted under the double damages MSP private cause of action. If primary payers are aware of Part C and D enrollment pre-settlement, conditional payments could be addressed in advance of settlement, allowing parties to rest assured that all liens are addressed, and the Medicare Advantage Plan can receive reimbursement. Additionally, PAID could arguably avoid the vast majority of the Medicare Advantage Plan MSP private cause of action double damages litigation. In short, the law is beneficial for everyone- beneficiaries, primary payers, and the Medicare Trust Fund alike. We know for certain that it is a saver for the U.S. Government as the Congressional Budget Office (CBO) has scored the PAID Act as a $25 million saver.
We encourage the industry to support the PAID Act. More information can be found here: http://www.marccoalition.com/take-action.html