Received Settlement Contract Today

[jayne]

unwrite it

[Bad Boy Bad Boy]

That's correct, it is written in their contract, and that would have been the issue I had removed. My Medicare Set-Aside Fund will be set up in my name, and wife (spouse) on the Account. It should also be in an Interest bearing Checking Account. I've been through that part years back. You will have to send a statement to CMS every once in awhile from the account. if any money is missing, you have to show medical reciepts pertain only to the injured body parts were paid for. if it's missing for other reasons, your required to replace it. Let that happen to many times, then you will have have a person or company appointed to the account. But her Attorney should have told then that too.

Her Attorney surely must be so new to this, that they miss the things from day one.

Medicare Set-Aside is not an option. It has to be done also. Her Attorney should have known that. And not have me as a Non-Attorney tell the facts.

Her Attorney should of explained, that in Illinois Open medical is like an Impossible ever heard of issue.

[maw19531]

I found this on the CMS site:Q6. WC Claim Resolution Where Medicals Remain Open – Is a WC Medicare Set-aside
Arrangement appropriate when resolution of the WC claim leaves the medical aspects of the
claim open?
A6. No. However, a WC Medicare Set-aside Arrangement is appropriate where the resolution
of the WC claim permanently closes the medical aspects of the claim, and the claimant will
require future medical services related to the WC claim that Medicare would otherwise
reimburse.
Please direct questions or concerns to Eve Fisher at (410) 786-5641.
/s/ Gerald
Walters

This tells me that if the IC leaves my medical open they don't need a medicare set aside. That's what they keep telling me. By the way my name is Mike Walsh. I am a He. Bad Boy if you have a fax I can send you a copy of this contract and you can tell me if I am missing anything else and you can see what I am talking about what they are saying about the set aside. They had a big downtown law firm draw up the contract.

[Bad Boy Bad Boy]

Your miss reading it.

In Illinois, when you settle it always states all portions of medical and whatever will be closed when the settlement contract is final.

First the Question;
(Is a WC Medicare Set-aside Arrangement appropriate when resolution of the WC claim leaves the medical aspects of the claim open?)

Second the Answer;
(No. However, a WC Medicare Set-aside Arrangement is appropriate where the resolution
of the WC claim permanently closes the medical aspects of the claim, and the claimant will
require future medical services related to the WC claim that Medicare would otherwise
reimburse.)


As written in Illinois Contracts of settlement. ((All portions of medical and whatever will be closed))

And the fact which is true; Had CMS performed their Invesigation on your case and future Medical yet? Did you ask CMS that????? Hello????

CMS applies that, because some States allow open medical you years and some for 3 years. They aren't going to write that statement as pertaining to each and every State. So they appy messages in it.

Your WC IC, can not do anything, without fully informing the CMS. If they won't then you need to.

Like I said before, what if the IC goes Belly up, you think medicare doesn't think of that???? Come on...

http://www.workerscompensation.com/medic...asides.php

Here's the thing, which I am not going to sit here all the time and keep explaining it.

No Medicare Set-Aside, then fine, CMS will apply a Lien on your Settlement money and simply lock that down so you can't use it.

Other than that think what you like.

[Bad Boy Bad Boy]

Maw, okay, look in your PM messages for my Fax Number. Then give me time to read it over.

[Bad Boy Bad Boy]

I think I'll apply this for everyone to view and read;

MSA, or "Medicare Set Aside'' accounts are now a requirement of civil suits as well as WC settlements. You are also now required to submit to CMS a Stipulated Award.
The Federal Gov't, SSA/Medicare and Congress are very serious about the shifting of liability for medical treatment where there is another party liable for such.

Attachments: EXCERPT OF LEGISLATION ins reporting.doc

CMS has not yet made any decisions regarding implementation and has no information to provide at this time.

EXCERPT OF LEGISLATION

SEC. 111. MEDICARE SECONDARY PAYOR.
(a) In General- Section 1862(b) of the Social Security Act (42 U.S.C. 1395y(b)) is amended by adding at the end the following new paragraphs:

`(7) REQUIRED SUBMISSION OF INFORMATION BY GROUP HEALTH PLANS-
`(A) REQUIREMENT- On and after the first day of the first calendar quarter beginning after the date that is 1 year after the date of the enactment of this paragraph, an entity serving as an insurer or third party administrator for a group health plan, as defined in paragraph (1)(A)(v), and, in the case of a group health plan that is self-insured and self-administered, a plan administrator or fiduciary, shall--
`(i) secure from the plan sponsor and plan participants such information as the Secretary shall specify for the purpose of identifying situations where the group health plan is or has been a primary plan to the program under this title; and
`(ii) submit such information to the Secretary in a form and manner (including frequency) specified by the Secretary.
`(B) ENFORCEMENT-
`(i) IN GENERAL- An entity, a plan administrator, or a fiduciary described in subparagraph (A) that fails to comply with the requirements under such subparagraph shall be subject to a civil money penalty of $1,000 for each day of noncompliance for each individual for which the information under such subparagraph should have been submitted. The provisions of subsections (e) and (k) of section 1128A shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). A civil money penalty under this clause shall be in addition to any other penalties prescribed by law and in addition to any Medicare secondary payer claim under this title with respect to an individual.
`(ii) DEPOSIT OF AMOUNTS COLLECTED- Any amounts collected pursuant to clause (i) shall be deposited in the Federal Hospital Insurance Trust Fund under section 1817.
`© SHARING OF INFORMATION- Notwithstanding any other provision of law, under terms and conditions established by the Secretary, the Secretary--
`(i) shall share information on entitlement under Part A and enrollment under Part B under this title with entities, plan administrators, and fiduciaries described in subparagraph (A);
`(ii) may share the entitlement and enrollment information described in clause (i) with entities and persons not described in such clause; and
`(iii) may share information collected under this paragraph as necessary for purposes of the proper coordination of benefits.
`(D) IMPLEMENTATION- Notwithstanding any other provision of law, the Secretary may implement this paragraph by program instruction or otherwise.
`(8) REQUIRED SUBMISSION OF INFORMATION BY OR ON BEHALF OF LIABILITY INSURANCE (INCLUDING SELF-INSURANCE), NO FAULT INSURANCE, AND WORKERS' COMPENSATION LAWS AND PLANS-
`(A) REQUIREMENT- On and after the first day of the first calendar quarter beginning after the date that is 18 months after the date of the enactment of this paragraph, an applicable plan shall--
`(i) determine whether a claimant (including an individual whose claim is unresolved) is entitled to benefits under the program under this title on any basis; and
`(ii) if the claimant is determined to be so entitled, submit the information described in subparagraph (B) with respect to the claimant to the Secretary in a form and manner (including frequency) specified by the Secretary.
`(B) REQUIRED INFORMATION- The information described in this subparagraph is--
`(i) the identity of the claimant for which the determination under subparagraph (A) was made; and
`(ii) such other information as the Secretary shall specify in order to enable the Secretary to make an appropriate determination concerning coordination of benefits, including any applicable recovery claim.
`© TIMING- Information shall be submitted under subparagraph (A)(ii) within a time specified by the Secretary after the claim is resolved through a settlement, judgment, award, or other payment (regardless of whether or not there is a determination or admission of liability).
`(D) CLAIMANT- For purposes of subparagraph (A), the term `claimant' includes--
`(i) an individual filing a claim directly against the applicable plan; and
`(ii) an individual filing a claim against an individual or entity insured or covered by the applicable plan.
`(E) ENFORCEMENT-
`(i) IN GENERAL- An applicable plan that fails to comply with the requirements under subparagraph (A) with respect to any claimant shall be subject to a civil money penalty of $1,000 for each day of noncompliance with respect to each claimant. The provisions of subsections (e) and (k) of section 1128A shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). A civil money penalty under this clause shall be in addition to any other penalties prescribed by law and in addition to any Medicare secondary payer claim under this title with respect to an individual.
`(ii) DEPOSIT OF AMOUNTS COLLECTED- Any amounts collected pursuant to clause (i) shall be deposited in the Federal Hospital Insurance Trust Fund.
`(F) APPLICABLE PLAN- In this paragraph, the term `applicable plan' means the following laws, plans, or other arrangements, including the fiduciary or administrator for such law, plan, or arrangement:
`(i) Liability insurance (including self-insurance).
`(ii) No fault insurance.
`(iii) Workers' compensation laws or plans.
`(G) SHARING OF INFORMATION- The Secretary may share information collected under this paragraph as necessary for purposes of the proper coordination of benefits.
`(H) IMPLEMENTATION- Notwithstanding any other provision of law, the Secretary may implement this paragraph by program instruction or otherwise.'.
(b) Rule of Construction- Nothing in the amendments made by this section shall be construed to limit the authority of the Secretary of Health and Human Services to collect information to carry out Medicare secondary payer provisions under title XVIII of the Social Security Act, including under parts C and D of such title.
© Implementation- For purposes of implementing paragraphs (7) and (8) of section 1862(b) of the Social Security Act, as added by subsection (a), to ensure appropriate payments under title XVIII of such Act, the Secretary of Health and Human Services shall provide for the transfer, from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of such Act (42 U.S.C. 1395t), in such proportions as the Secretary determines appropriate, of $35,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for the period of fiscal years 2008, 2009, and 2010.

[Bad Boy Bad Boy]

http://www.wayneeklund.com/msa/the%20use...asides.pdf

I also have an opinion;

If for some reason, there is any doubt to what ones Medicare Set-Aside is, should be, how it applies, and if all parties are working in the best interest of Medicare (CMS). Then I say hire an Administrator to handle the account of medical and pharmacical issues. Normal set up fee runs around $10,000.00 and paid by the IC.

IC's bank their money and thoughts on the issue many with Medicare Set Asides Funds very seldom use their funded money up. Being said, after 5 years the IC can then appeal with the CMS for a reduction in the Set Aside amount being placed in such fund, and also obtain a 25% refund from the fund money already in place. They can perform this every 5 years.

Also the fact the the IC's banks their money on the issue, one will not live out their full life of expected funding in the years needed to be applied.

Administrator's;

http://medicaresetasideblog.com/2008/06/...ation.aspx

http://www.cypresscare.com/services_MSA.htm


Use your Medicare Set Aside Funds, use them up, to keep the money going into the fund.

You also must remember, it's not your money, it's the IC's money, and to only pay for your injured body parts area.

I just don't know any other better way to say all this in the plain lanague I'm using so all can understand. For if I wrote in terms of the legal system, not many would understand it, maybe not even me.

[Bad Boy Bad Boy]

Well, I guess we can now leave this Thread as good reading and a knowledge base for others now.

Surely Maw can explain the rest.

Good luck Maw, and stay safe.