07-29-2009, 04:50 PM
kate Wrote:CMS reviews settlements in the following situations:
* The claimant is currently a Medicare beneficiary and the total settlement amount is greater than $25,000; OR
* The claimant has a "reasonable expectation" of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.
An individual has a "reasonable expectation" of Medicare enrollment if any of the following situations apply:
(a) The individual has applied for Social Security Disability Benefits;
(b) The individual has been denied Social Security Disability Benefits but anticipates appealing that decision;
© The individual is in the process of appealing and/or re-filing for Social Security Disability Benefits;
(d) The individual is 62 years and 6 months old (i.e., may be eligible for Medicare based upon his/her age within 30 months); or
(e) The individual has an End Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD.
A WCMSA should be placed in an interest bearing account. WCMSAs should also be administered by a competent administrator (the representative payee, a professional administrator, etc.). When a claimant designates a representative payee, appointed guardian/conservator, or has otherwise been declared incompetent by a court; the settling parties must include that information in their Medicare set-aside arrangement proposal to CMS.
In addition, the claimant may self-administer his or her own WCMSA, if permitted under State law. Claimant should submit an annual self-attestation form when monies have been exhausted.