CMS Withdraws Proposed Rule on Future Medicals in Liability Settlements


The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program (SCHIP), and health insurance portability standards.

On October 8, 2014, the CMS published a notice of withdrawal for its proposed rule entitled Medicare Secondary Payer and “Future Medicals” (CMS-6047-P).  CMS had originally published an Advanced Notice of Rulemaking (ANPRM) on June 15, 2012 in which it proposed seven options for protecting Medicare’s interests stemming from future medicals in liability settlements.  Subsequently, in August 2013, CMS provided to the federal Office of Management & Budget, a Notice of Proposed Rulemaking which appeared to indicate the release of proposed rules in the near future.  However, since that time there had been no further communication from CMS until this notice of withdrawal.

The specific reasons for the withdrawal are unknown and it is further unknown whether CMS will be proposing a revised or new rule.  We are not prepared to assume that this action signals CMS is no longer concerned with future medicals in liability settlements without an affirmative statement from CMS to this effect.  Nonetheless, the withdrawal does signal the difficulties for CMS in putting a formal structure in place to address these future medicals.

Until CMS provides clarity to this issue, settling parties should continue to carefully review the Medicare Secondary Payer Act and CMS rules and regulations in determining whether Medicare’s interests have been appropriately considered in the resolution of a liability case.  This is particularly important when the parties are knowingly shifting the burden of future, injury-related, medical care to Medicare as a result of the settlement.

If you or someone you know has sustained a work-related injury, call us at 317-569-9644. The attorneys at Klezmer Maudlin offer free advice and only charge a fee if you need us.  We can help you navigate the deadlines and the forms, and we can help you get the treatment you need and the settlement you deserve.

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