Blog Post

Liability Medicare Set Asides  (LMSA)

John Darer • Aug 09, 2018

What is Current CMS Thinking About Liability MSA?

 

Members of the National Association of Settlement Purchasers met with the Center for Medicare and Medicaid Services (CMS) recently to discuss what's doing with Liability Medicare Set Aside Arrangements.

 

Some highlights of the meeting as reported by my colleague Tom Stanley:

 

  • CMS stated they have an 18-month timeframe (from April 2018) before it rolls out a LMSA Review program.
  • The program would be voluntary.
  • CMS has indicated that their enforcement mechanism is the denial of services.
  • CMS felt strongly that the injured party must receive something (free and clear) through settlement.
  • CMS would not review an LMSA until Settlement has been reached.
  • CMS feels a LMSA is exclusively the responsibility of the plaintiff.
  • Regarding LMSA’s, CMS made it clear that the defendant(s), and their insurers, are not a target .
  • Medicare pricing of services was discussed.
  • CMS does not feel it can mandate professional administration.
  • CMS would publish a LMSA Reference Guide.
  • Eligibility remains the same as the current WCMSA system – Medicare beneficiaries or injured parties who have a reasonable expectation of Medicare eligibility within 30 months. Per statute, Medicare’s interest must be considered in every claim.
  • A workload threshold of $250,000 is anticipated - “NO SAFE HARBOR”. This level mirrors the $25,000 workload threshold for WCMSA’s.
  • For settlements between $250,000 and $750,000 threshold, CMS approval is available and encouraged by CMS. CMS would apply “ a formula” to determine the LMSA amount. Starting with the total settlement amount , CMS would subtract certain expenses and apply the discount factor to total settlement.
  • Above $750,000 level is a full commutation. A traditional MSA would be prepared and, if submitted to CMS, evaluated by CMS for adequacy.

 

Learn more about

Medicare Set Aside Arrangements


risk adjusted capital ratio and structured settlements

What is Risk Adjusted Capital Ratio (RACR)?

By John Darer • 07 May, 2024
What is Risk Adjusted Capital Ratio (RACR) What does RACR Ratio mean forr your structured settlement annuity company, or one that you are considering. How does RACR compare with RBC Ratio?
Risk Based Capital

What is Risk Based Capital?

By John Darer • 06 May, 2024
What is Risk Based Capital? What Does the RBC Ratio Mean for Your Structured Settlement Annuity Company?
certified financial transitionist

What is A Certified Financial Transitionist? (CeFT)

By John Darer • 25 Apr, 2024
A Certified Financial Transitionist is trained and certified to help clients navigate through major life events and the financial transitions that accompany them. Especially useful for personal injury victims and wrongful death survivors to help prepare for the important decisions they will need to make.
Sequencing Risk for Those Receiving Legal Settlements

What is Sequencing Risk? Can Structured Settlements Help?

By John Darer • 22 Apr, 2024
John Darer reviews sequencing risk and the impact of early spending after settlement. Sequencing and Decumulation risk is a factor for recipients of legal settlements and should be addressed in advance of settlement as aprt of settlement planning and wealth orientation.
structured settlement rate lock ins

What is a Structured Settlement Lock-in?

By John Darer • 21 Apr, 2024
A structured settlement lock-in means that the structured settlement annuity issuer will guarantee the cost of a specific benefit stream in exchange for the "quid pro quo" of a commitment to accept or purchase. The guarantee could be a week , or 6 months.
market based structured settlements for lawyers, law firms or plaintiffs

Market Based Structured Settlements | How They Work

By John Darer • 14 Apr, 2024
An introduction to Market Based Structured Settements for Plaintiffs, Lawyers and Law Firms and Settling Parties
new york structured settlements, new york city structured settlements, nyc structured settlement cos

New York City Structured Settlement Annuities 2024

By John Darer • 16 Mar, 2024
Which life insurance companies write structured settlement annuities for personal injury and wrrongful death settlements in Bronx, Brooklyn, Staten Island, Queens, Manhattan, Long Island, Westchester, Erie, Rockland, Albany,Monroe in 2024 through licensed representatives?
flying inverted

NY CPLR 50A/50B | Rising Yields 2022-2024 Squeezed 15 Year Plaintiff Advantage

By John Darer • 16 Mar, 2024
While rising yields have narrowed the gap for defendants in New York CPLR 50A and 50B projections, plaintiffs can still " fly inverted" and get plenty of "lift" when negotiating settlements by using savvy settlement experts
construction defect structured settlements

Construction Defect Structured Settlements

By John Darer • 12 Mar, 2024
Structured settlements can be used where construction defects lead to personal physical injury, physical sickness, or loss of life. In addition, structured settlements may be helpful to plaintiffs who wish to spread out basis, smooth out capital gains or income
structured settlement beneficiary

Structured Settlement Beneficiary Death Claim | What You Need to Know 2024

By John Darer • 08 Mar, 2024
Structured settlement beneficiary death claim. An executor cannot change the beneficiary of a structured settlement annuity. Typically, settlement agreements permit the Payee to name or change a beneficiary, provided such change is in writing and submitted to the Assigmment Company or the annuity issuer in writing and in proper form. An executor is a court appointed representative of the decedent, or in this case, deceased structured settlement annuitant. The insurance beneficiary designation is a contract between the decedent and the insurance company that was entered into prior to the decedent's death.
More Posts
Share by: