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NAMSAP April 2018 Newsletter
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NAMSAP Quarterly Newsletter

Volume 11, Number 1 | April 2017

01 | President's Letter

By: Rita Wilson
Chief Executive Officer
Tower MSA Partners

Dear NAMSAP Members: 

Welcome sweet springtime!  As we look ahead in anticipation of the onset of spring, I wanted to take this opportunity to share with each of you the results achieved over the past 3 months and to highlight the work that continues on behalf of NAMSAP. Below you will find a recap of the initiatives put in play this quarter through the combined efforts of Julie’s team at Association Management Services (AMS) and the NAMSAP board of directors, committees and membership.  To be sure, Q1 has been both busy and productive!

As mentioned in January’s letter, with education at the forefront of NAMSAP’s mission, a key objective of the education committee was to set topics and schedule dates for the 12 webinars planned in 2018.  The first two webinars are already behind us! Looking Ahead to 2018, presented on February 27, 2018 by Dan Anders, Esq. (Tower MSA Partners), Rasa Fumagalli, Esq. (NuQuest), and Ciara Koba, Esq. (Burns & White), and Intro to ODG, presented on March 13, 2018 by Tom Farrell (ODG), were both extremely well received by the attendees with the ODG webinar coming in as one of the highest attended webinars in NAMSAP history.  (As a reminder, access to ODG can be purchased at a significant discount to active NAMSAP members.  For more information and to purchase, please email info@namsap.org).

Webinars scheduled for the remainder of 2018 are listed below and can also be found at http://www.namsap.org/events/event_list.asp?.  The April 24th webinar announcement was released last week with registration information available at https://namsap.site-ym.com/events/register.aspx?id=1091098&itemid=24aac186-b67a-44bc-829f-ac465babb263. Webinar topics slated for 2018 include:

  • Dual Coverage & Special Needs Trusts (May 22, 2018)
  • Opioids in the MSA – Part III (June 19, 2018)
  • Medicare Part C (July 17, 2018)
  • REDBOOK (August 14, 2018)
  • MSA Cost Mitigation Strategies (September 1, 2018)
  • Case Law Update (October 3, 2018)
  • ODG – How, Where and When to Use? (October 26, 2018)
  • LMSA Update (November 13, 2018)     
  • Annual Ethics Update (December 18, 2018)
  • Year in Review (January 15, 2019)

One of the most exciting initiatives of 2018 has been to extend NAMSAP’s advocacy to CMS to stop the institutionalization of opioids over life expectancy that continues under its review process for WCMSAs. Through the leadership of Gary Patureau and Amy Bilton, the EBM Committee is aggressively seeking to extend national awareness of this issue through communication with national organizations and legislators, and also via direct dialogue with CMS.  Toward that end, I am pleased to announce that on April 5, 2018, letters were sent from NAMSAP’s EBM Committee Co-chairs, Gary Patureau and Amy Bilton, to all Congressional delegates to educate them as to what is happening under CMS’s WCMSA review and to communicate the initiatives taken by NAMSAP to recommend policy changes in support of evidence based medicine in CMS’s review of opioids in the MSA.  More information and to review the full package submitted to each delegate, go to http://www.namsap.org/default.asp?page=EBMOpioidInitiative .  The letters will be followed by digital communications to each member to offer further dialogue to explain what is happening and to encourage their support of our efforts to modify CMS’s behavior.

Another strategic goal for 2018 is to share NAMSAP’s industry knowledge and expertise by creating our own Speakers’ Bureau.  As an adjunct to its use internally to support NAMSAP webinars, NAMSAP Advisor newsletter content and NAMSAP’s Annual Educational Conference, this service will extend NAMSAP’s expertise outside of our organization and places NAMSAP at the forefront of education in the MSP industry. If you haven’t already done so, I encourage each member to complete the Speakers’ Bureau Survey and begin to share your knowledge.

As we look ahead to the NAMSAP 2018 National Educational Conference in Baltimore, MD on October 3-5, I hope everyone has take advantage of the Super Early Bird Registration discount and secured a room at the beautiful, historic Lord Baltimore Hotel!  Conference Co-chairs Michelle Allen and Gary Patureau have completed the agenda, and are now actively working to secure speakers from all areas of the MSP industry.   With the newly implemented contractors for the WCRC and CRC, we anticipate active participation by CMS at this year’s conference.  We also expect involvement by legislators who are leading our charge on opioids, and by our own member experts from both the payer and service provider communities. And don’t forget that those who have completed NAMSAP’s MSCC course within the required period of time prior to the conference date can arrange to take the MSCC test prior to conference start date. Please make plans now to join us in Baltimore!

Other activities that began in Q1 and remain ongoing as we continue into Q2, include the following:

  1. Transition of all NAMSAP website information to the industry standard YM platform and established a process to add NEWS, etc. and update our website dynamically.
  2. Implementation of www.NASMAP.org website refresh project to revamp our current website to better represent us as a vibrant, action oriented, driven organization.
  3. Creation of a BOD orientation power point to provide training / orientation to our BOD and Advisory Committee to set appropriate expectations.  This is something NAMSAP, as an organization, never had.
  4. Deployment of a NAMSAP calendar to be shared via the new to showcase all activities for the year in a single view.
  5. Implementation of a robust educational platform to support the MSCC training program.  Looking ahead this platform may also allow us to take our webinar process to a whole new level of professional presentation abilities.

As you can see, 2018 continues to be an active year for NAMSAP.  As the only non-profit organization dedicated to MSP compliance, we are uniquely positioned to drive change in our industry through collaboration, advocacy and education.  Our 2018 Strategic Plan is dedicated to this purpose. To achieve our collective goals, however, we need the focused efforts and active involvement of every member of this talented organization.

I welcome your feedback on the information shared, and your involvement and support as we continue to push forward.

In the words of Mark Twain, “The secret to getting ahead is to get started.”

 
 

02 | Webinar Highlights

Highlights of The MSP – Looking Ahead to 2018 Webinar/ by Dan Anders Esq/ Tower MSA Partners

In a February 27, 2018, NAMSAP sponsored webinar, Daniel Anders of Tower MSA Partners, Rasa Fumagalli of NuQuest and Ciara Koba of Burns White, presented their views on the past, present and future of MSP compliance.  In this engaging webinar the three MSP compliance attorneys took on major compliance issues such as the July 2017 revised WCMSA Reference Guide, the transition to the new CRC contractor and the potential for CMS liability MSA reviews in 2018. 

Please find below a breakdown of the highlights of the webinar and the following is a link to the recorded webinar:  The MSP - Looking Ahead to 2018

The Past – Recap of 2017 events

  • Capitol Bridge, LLC awarded contract as the new WCRC
  • WCRC contract includes provision to expand MSA reviews to liability as early as July 2018.
  • July 10, 2017 release of revised WCMSA Reference Guide which among many notable items, introduced the Amended Review process, provided guidelines for recognizing state specific statutes for limiting medical care in the MSA and recommended professional MSA administration.

Present – Notable Current Events

  • Details on the transition to the new Commercial Recovery Center contractor, Performant, LLC
  • What’s new with the CMS portals?
  • Developments in the class action lawsuits filed by MSP Recovery, LLC, against no-fault insurers
  • Introduction of the new Medicare ID

Future - Expectations for 2018 and Beyond

  • Possible expansion of CMS MSA review process to liability settlements
  • Addressing opioids in MSAs
  • Continued Medicare Advantage Plan litigation
 

03 | Regulation Update

A Detailed Look at the Amended Review Process
By: Rasa Fumagalli J.D.
MSCC/ NuQuest

Version 2.6 of the Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide (“Reference Guide”) released on July 10, 2017, introduced the “Amended Review” process in Section 16.3. This addition was greeted with enthusiasm since it now allows parties, who were unable to settle their claim after receipt of the initial CMS determination, to ask CMS to review an updated MSA based on the claimant’s current medical condition provided certain conditions are met.  A closer examination of these pre-requisites is warranted in order to ensure that CMS will actually consider the request for re-review.

Pre-requisites for the Amended Review

Section 16.3 indicates that CMS will permit a one-time request for re-review when the following criteria are met: 1. CMS has issued a conditional approval/approved amount at least 12 months but no more than 48 months prior; 2. The case has not yet settled as of the date of the request for re-review; 3. The projected care has changed so much that the submitter’s new proposed amount would result in a 10% or $10,000.00 change, whichever is greater, in CMS’ previous approval amount; 4. When a re-review request is approved by CMS, the new approved amount will be effective as of the date of the settlement.

In the event that the treatment has changed due to a state specific requirement, there must be a life care plan that shows the replacement treatment for the denied treatment if it is not reflected in the medical records. In addition, CMS will not consider a change that is due to the approval of a new generic version of a medication by the FDA that reduces the cost of the drug projection, to be a sufficient reason for a re-review request. 

In addition to the above requirements, CMS has also outlined a very specific format for the amended review. The submission must have the following: a new cover letter, all medical documentation related to the settling injury(s)/body part(s) since the previous submission date, the most recent six months of pharmacy records, a Consent to Release information and a summary of the future care. Justification for the change in care must reference the CMS recommendation sheet and identify:  the line items that included care that was already provided; the line items that are no longer required and include the replacement care and add new line items showing any additional care that is needed. Support in the medical records must be provided for each requested change. CMS will decline a review if the submitter fails to provide justification. Submitters are also not allowed to supplement the request for amended review.

Points to Consider when using the Amended Review process

In using the amended review process, parties should be mindful of the provision’s requirement to submit  all medical documentation related to the settling injury(s)/body part(s) since the previous submission date.”  Since the amended review can be pursued up to 48 months from the date of the initial CMS determination, this requirement covers more than the last two years of injury related treatment records that are needed to support an initial CMS proposal submission. In addition, the date of the initial submission will not always be the same as the date of the last medical record that was submitted. In the event that any of these medical records reference treatment with another physician that may arguably be treating the claimant for any of the “settling injury(s)/body part(s), those records must also be secured and factored into the updated MSA.  This is true even though the carrier may not have paid for any of the treatment from the provider that is referenced in another physician’s record. In light of this, careful scrutiny of the new medical records is recommended.

If additional conditions are being added to the settlement, these additional conditions must also be included in the amended review analysis by CMS. If the additional conditions were denied, without any payments made for them, CMS will look for the same type of documentation that would accompany an initial submission with these denied conditions. Payment histories run from the date of the alleged accident and dated within six months of the amended review request will have to be provided in order to support the denial of the conditions. A letter outlining the denied and accepted conditions will also be needed. Since CMS will not allow submitter’s to supplement the amended review, this information must accompany the amended review submission.

The timing of the amended review submission is also important. It should be done with a view towards maximizing the reduction of the allocation, when possible. In cases involving CMS determinations with opioids, the successful implementation of a weaning program would likely yield a significantly lower updated MSA and amended review determination.

The amended review process is beneficial for those who are seeking CMS’ approval of an updated MSA when there is a CMS determination on file. The process however does require that certain conditions be met and that specific documents be provided to CMS.  Given CMS’ strict interpretation of the amended review process, parties should be aware of and prepared to comply with each of the pre-requisites. 

 

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