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The new legislation, H.R. 1063, “The Strengthening Medicare and Repaying Taxpayers (SMART) Act,” is similar to a bill introduced last year which did not gain traction. H.R. 1063 was introduced by Rep. Tim Murphy (R-PA) and Rep. Ron Kind (D-WI) last week prior to the recess. 

“RIMS is hopeful that this new bipartisan bill, which is also expected to be introduced in the Senate, will gain traction this Congress, sooner rather than later,” says John Phelps, director, business risk solutions, Blue Cross and Blue Shield of Florida, Inc. and board liaison RIMS External Affairs Committee. “Passage of this legislation is essential to help our members deal more effectively and efficiently with the problem of getting timely information to Centers for Medicare and Medicaid Services (CMS) regarding payments made by insurers to Medicare recipients who have also been paid earlier for their injuries through Medicare.” 

H.R. 1063 amends provisions 2007 law which requires insurers to report every settlement or other payment made to a beneficiary to CMS. Violations of the reporting requirements may be imposed by CMS at $1,000 per day for each violation.  This bill is helpful to all RIMS members, but particularly our public sector entities, which face this hurdle on a very regular basis.

If passed, H.R. 1063 would be beneficial to self-insurers, insurers and those payers under nongroup health plans by permitting them to communicate with CMS to determine with greater clarity their obligations to CMS in a timely manner.  Additionally, H.R. 1063 would permit CMS the latitude to impose fines up to $1,000 per day. The legislation would also create a right of appeal to challenge a repayment amount to all parties rather than just being restricted to Medicare recipients under the current statute.