The National Alliance of Medicare Set-Aside Professionals (NAMSAP), the only national professional association whose singular focus is Medicare Set-Aside arrangements (MSAs), celebrated its 10th anniversary last week in Las Vegas with a congratulatory acknowledgement of past accomplishments, a comprehensive educational program and a confident look at the future.
Incoming NAMSAP President Leslie Schumacher and Immediate Past President Douglas Shaw complimented NAMSAP's founding members for their innovative spirit and sustaining priorities: education; best practices; and certification - the Medicare Set-Aside Consultant Certified (MSCC) program.
Schumacher and Shaw highlighted NAMSAP's recent accomplishments and enhanced membership value: expanding membership; regional conferences; educational webinars; a recurring "legal roundtable"; an active website listserv; improved communications with CMS; a new strategic plan; and sponsorship of NAMSAP's first "Take the Hill" Day in Washington D.C.
NAMSAP also seeks and welcomes opportunities to help improve MSA and settlement planning industry standards for documentation, work product and business practices, according to Shumacher and Shaw.
MSP Act and MSAs
NAMSAP's growth has paralleled the expansion of workers compensation MSAs (WCMSAs) to satisfy the requirements of the Medicare Secondary Payer (MSP) Act. Enacted in 1980, the MSP Act requires certain insurers, including liability, automobile, no-fault and workers compensation insurers, to make payment first for services to Medicare beneficiaries regarding claimed injuries, with Medicare responsible only as a “secondary payer.”
The Centers for Medicare and Medicaid Services (CMS), the agency responsible for administering Medicare policies, failed to take practical steps to enforce the MSP rules until 2001 when it issued the first of several policy memoranda addressing WCMSAs. These policy memorandums created a format, checklists and procedures for seeking approval for WCMSAs to "protect Medicare's interests" when workers compensation cases are settled.
CMS subsequently published a WCMSA Reference Guide (WCRG) on March 29, 2013 plus a WCRG Version 2.0 on November 7, 2013. The WCRG's intended purpose: to help WCMSA professionals, beneficiaries and other stakeholders "understand CMS' [WCMSA] amount approval process and to serve as a reference for those electing to submit such proposals to CMS for approval."
The WCRG explains WCMSAs as follows: "A WCMSA allocates a portion of the WC settlement for all future work-injury-related medical expenses that are covered and otherwise reimbursable by Medicare. When a proposed WCMSA amount is submitted to CMS for review and the individual or beneficiary obtains CMS’approval, the CMS-approved WCMSA amount must be appropriately exhausted before Medicare will begin to pay for care related to the beneficiary’s settlement, judgment, award, or other payment."
Both the CMS policy memoranda and the WCRG address structured settlement issues and provide guidelines for their utilization in funding WCMSAs.
WCMSAs represent one of the few submarkets where structured settlements sales have increased since 2008 - in large part because the method CMS requires for calculating WCMSA present values provides an inherent cost advantage for annuities compared with lump sum alternatives.
CMS has not yet published definitive rules for using MSAs in liability cases (LMSAs). CMS did publish an Advanced Notice for Proposed Rule Making (ANPRM) on June 14, 2012 in the Federal Register which included seven different option to satisfy obligations for future medicals in liability cases. CMS also published RIN: 0938-AR43 in Spring of 2013 outlining a timetable for the proposed rule. No such LMSA rule, however, has yet been published.
Topics and Speakers
Among the challenges in selecting topics and speakers for any NAMSAP conference is the diversity of MSA subject matter expertise. A significant knowledge gap exists between many MSA attorneys and many MSA nurse/life care planner/allocators - with MSA administrators, insurance professionals and structured settlement brokers falling somewhere along this educational axis.
NAMSAP continues to select topics which, and attract speakers who, meet the learning needs of its multi-professional membership during a period of rapid industry change and development. The following S2KM listing of topics ( with speakers) attempts to communicate both the range of NAMSAP's 2014 annual conference educational offerings as well as NAMSAP's success in maintaining and expanding a unified MSA community of professional practice.
Directed Toward All MSA Professionals
- Professionalism in the MSA Industry - Preston Holloway; David Jankosky; Leta Sharkey.
- Problematic Areas in MSP Compliance - Lavonya Chapman; Stephanie Ragsdale; Linda Wolden.
- How Medication Impacts MSAs - Dr. Marcos Iglesias; Kayla Tortorich; Melissa Woitalewicz.
Directed Primarily Toward MSA Allocators
- Evidence Based Medicine - Dr. Shari Ling; Mary Nix; Ken Eichler; Beth Hostetler.
- Transitioning to ICD-10 - Marci Moorhead; Carlos Navarro.
Directed Primarily Toward MSA Attorneys
- Workers Compensation Cases with a Liability Component - William Delaney; Jill Schroeder.
- Dual Eligibility: MSAs within Special Needs Trusts - Kristen Behrens; Shannon Laymon-Pecoraro.
- Developments in the MSA Courtroom - Chelsie Allan; Patrick Czuprynski; Jennifer Santoro.
- Impact of Outside Factors on the Distribution of MSA Funds - Gregg Chapman; Danielle Marone; Daniel Simones.
Congratulations to the speakers, as well as NAMSAP's conference and educational committee chairmen Thomas Matson, Gary Patureau and Thomas Spratt, for maintaining NAMSAP's impressive educational standards.
For S2KM's most recent prior NAMSAP reporting, see "NAMSAP 2014 Regional Conference":
For S2KM's summary of structured settlement issues in the CMS WCMSA Reference Guide, see this blog post.