Examples of MSP Statute in a sentence
In addition, insurers challenged CMS's position that a broad general release (which would include, by implication, post-December 5, 1980 liability) could itself ever trigger Section 111 obligations, finding CMS's assumption unsupported by the language of the MSP Statute and its legislative history.
To impose such obligations would give retroactive application to the MSP Statute in violation of long-standing constitutional principles.
As stated by AIA in a recent follow-on letter to CMS, "by clarifying the application of the MSP Statute and Section 111 obligations in relation to Group 2 Claims, CMS can remove an important area of uncertainty for all affected parties (beneficiaries, their counsel, NGHP and counsel, even judges and courts)." We participated in the September 29 call with CMS and would be happy to discuss the proposed reporting exception in more detail with interested clients.
Under the Medicare Secondary Payer (MSP) Statute, CMS may seek recovery of its payments to medical providers if it learns an insurer had the obligation to pay those costs as the primary payer, regardless of whether that insurer has made payment to the provider or Medicare beneficiary.
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Beginning in 1980, Congress enacted a series of laws known collectively as the MSP Statute, 42 U.S.C. § 1395y(b)(2), which made Medicare the secondary payer to certain other primary plans specifically to shift costs from Medicare to private sources of payment.
The MSP Statute specifically provides that, if a primary plan “has not made or cannot reasonably be expected to make payment with respect to such item or service promptly,” Medicare pays for those medical expenses, but those payments are conditioned on reimbursement if it is demonstrated that aprimary plan had responsibility to pay for those medical expenses.
Centura, in contrast, asserts that the MSP Statute prohibited treating Medicare as a primary payer and that, therefore, it could not have been a “primary medical payer of benefits” under the Lien Statute.
The third element in establishing MSP liability is to show that Monsanto, Solutia and Pharmacia are responsible primary plans under the MSP Statute.
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