The Medicare recommendations/regulations that the Maryland Workers Compensation Commission has adopted must be considered in settlement of any claim. That is, in any case where medical treatment will be closed as part of the settlement, that settlement agreement must take Medicare's interest in to account. These recommendations/regulations are based upon the Medicare secondary payer act as set forth in 42 CFR $ 411. The bottom line is that all parties must take Medicare's interest into account if the settlement involves settlement of future medical treatment. In some cases, this will require getting a Medicare set aside trust or obtaining approval from the Center for Medicare Services. The specific recommendations are as follows:
If your settlement falls within the Center for Medicare services threshold, you must obtain approval from Medicare before the Maryland Workers Compensation Commission will approve your settlement. Medicare must approve the amount being set aside for future medical treatment. A settlement will fall under the Medicare threshold if: (1) the claimant is a Medicare recipient and the case is settled for over $25,000 or (2) the case is settled for over $250,000.00 with a reasonable expectation that the claimant will be on Medicare within the next 30 months. A "reasonable expectation" is when the claimant (1) is 62.5 years of age; or (2) is currently receiving SSDI; 0r (3) has applied for SSDI; or (4) suffers from end stage renal disease.
The Maryland Workers Compensation Commission will not approve the settlement unless CMS has approved the amount that has been allocated for future medical treatment.
If the settlement claimant falls outside of the Medicare threshold, your agreement must contain specific language that Medicare's interests have been considered and (1) either identify an amount of money that has been set aside in an MSA; or (2) apportion an amount to be used for future medical expenses(this must be supported by a medical opinion).
