On Friday, February 27, 2015, the Centers for Medicare & Medicaid Services (CMS) published its Final Rule implementing provisions related to appeal rights being granted to Applicable Plans [defined as liability insurance (including self-insurance), no-fault insurance, or a workers’ compensation law or plan] by the Strengthening Medicare and Repaying Taxpayers (SMART) Act. The SMART Act amended the Medicare Secondary Payer (MSP) Act in 2013 in several ways. One way was to grant Applicable Plans a right to appeal final determinations from CMS when CMS pursued the Applicable Plan for reimbursement.
This Final Rule is a significant step by CMS in implementing the SMART Act provisions. In short, CMS intends to provide Applicable Plans the same appeal rights as it currently provides Medicare beneficiaries. Those rights include the ability to access a multi-level process including a redetermination by the contractor issuing the recovery demand, a reconsideration by a Qualified Independent Contractor, an Administrative Law Judge hearing, a review by the Departmental Appeals Board’s Medicare Appeals Council, and eventual judicial review once the beneficiary has standing to pursue such action.
This Final Rule becomes effective April 28, 2015.