BILL ANALYSIS
AJR 42
Page 1
Date of Hearing: June 15, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AJR 42 (Solorio) - As Introduced: May 28, 2010
SUBJECT : Medicare Secondary Payer Enhancement Act of 2010.
SUMMARY : Makes specified legislative findings and declarations
regarding H.R. 4796, the Medicare Secondary Payer Enhancement
Act of 2010 (MSPEA) and requests that the Congress and the
President of the United States enact MSPEA. Specifically, this
resolution :
1)Makes the following declarations regarding the federal
Medicare Secondary Payer (MSP) law:
a) It is an important law that is designed to protect the
Medicare Trust Fund and ensure that Medicare pays only for
medical expenses for which it is responsible;
b) With respect to claims involving individuals who are
eligible for the Medicare Program, it has caused
considerable delay and unfairness in settlement of claims;
and,
c) The delays in settlement of claims and uncertainty of
the scope of responsibility for Medicare has increased
settlement costs.
2)States that the MSPEA has received bipartisan support and is
supported by a broad coalition.
3)Respectfully requests that the Congress and the President of
the United States enact MSPEA.
EXISTING FEDERAL LAW :
1)Establishes in federal law the Medicare Program as a
government-administered health insurance program for people
age 65 or older and certain people younger than age 65, such
as those with disabilities and those who have permanent kidney
failure or amyotrophic lateral sclerosis (Lou Gehrig's
disease).
AJR 42
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2)Establishes the federal MSP law, designed to protect the
Medicare Trust Fund and ensure that Medicare pays only for
medical expenses for which it is responsible.
3)Requires that all entities that bill Medicare for services or
items rendered to Medicare beneficiaries must determine
whether Medicare is the primary payer for those services or
items.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . The author states that the
California Congressional delegation occupies many positions of
leadership in both the Senate and House of Representatives.
Expressing to the delegation the need for passage of MSPEA
will greatly assist in the passage of that bill.
2)MEDICARE SECONDARY PAYER . According to the Centers for
Medicare and Medicaid Services (CMS), since 1980, the MSP
provisions have protected Medicare funds by ensuring that
Medicare does not pay for services and items that certain
health insurance or coverage has primary responsibilities for
paying. The MSP provisions apply to situations when Medicare
is not the beneficiary's primary insurance. It provides
program savings, increased provider, physician, and other
supplier revenue, and avoids Medicare recovery efforts. CMS
states that maintaining the viability and integrity of the
Medicare Trust Fund becomes critical as the Medicare Program
matures and the "baby boomer" generation moves toward
retirement. Providers, physicians, and other suppliers can
contribute to the appropriate use of Medicare by complying
with all Medicare requirements, including those applicable to
the MSP provisions.
3)MEDICARE SECONDARY PAYER ENHANCEMENT ACT OF 2010 . The MSPEA
was introduced on March 9, 2010 to address inefficiencies and
problems in the MSP system that make it nearly impossible for
many parties to determine how much is owed to Medicare. There
is currently no appeal process for an entity with MSP
responsibility that disagrees with Medicare's calculation,
which results in claims not being resolved in a timely manner.
In an effort to enhance efficiencies of the process, the
MSPEA would revise the flow of information so parties know how
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much is owed to Medicare before settling, create a right of
appeal for parties who disagree with MSP calculation and
establish a reasonable statute of limitations, adopt a
sensible MSP recovery threshold so that Medicare does not
spend more taxpayer money pursuing a claim than the claim is
actually worth, and removes the requirement that Medicare
beneficiaries disclose sensitive personal ID numbers.
4)ARGUMENTS IN SUPPORT : According to the Pacific Compensation
Insurance Company this Resolution will encourage Congress to
pass MSPEA, which will help Medicare beneficiaries by
providing them important information about potential MSP
claims, and allowing them to more quickly settle claims they
may have against third parties. Additionally, this
legislation will help all parties navigate through this
complex issue, ensuring that the Medicare Trust Fund is timely
and appropriately reimbursed and all interested parties are
protected from the uncertainty currently surrounding the
process.
REGISTERED SUPPORT / OPPOSITION :
Support
California Applicants' Attorneys Association
California Association of Joint Powers Authorities
California Professional Association of Specialty Contractors
Medicare Advocacy Recovery Coalition
Pacific Compensation Insurance Company
Small Business California
Workers' Compensation Action Network
Opposition
None on file.
Analysis Prepared by : Martin Radosevich / HEALTH / (916)
319-2097