Commonsense reforms to the arcane MSP policy offer a simple and taxpayer-friendly solution to increase stakeholder certainty and remove barriers to care.
FOR IMMEDIATE RELEASE
Contact: Andrew Rosenberg (firstname.lastname@example.org), (202) 247-6301
February 17, 2017 – The Medicare Advocacy Recovery Coalition (MARC) today lauded Rep. Tim Murphy (R-PA) and Ron Kind (D-WI) for their introduction of the Secondary Payer Advancement, Rationalization, and Clarification (SPARC) Act (H.R. 1122) – a bipartisan measure to improve the Medicare Secondary Payer (MSP) program in Medicare Part D. While the MSP policy is designed to ensure that the Medicare program and prescription drug plans (PDPs) do not reimburse healthcare expenses for which another entity is legally responsible, literally every stakeholder agrees that the process by which PDPs recapture payment for claims that were not its responsibility to pay is broken. The SPARC Act will significantly improve the efficiency of the current system, providing a clear framework for communication among all stakeholders involved.
“The SPARC Act will create a clear and functional MSP system for Part D drugs, benefitting Medicare beneficiaries and Part D Drug Plans alike” said Greg McKenna, Chair of the MARC Coalition and Senior Vice President for External Affairs of Gallagher Bassett Services Inc. “Today’s complicated regulatory atmosphere leads to inappropriate coverage denials for beneficiaries; costly, but mandatory pursuit of miniscule recoveries; and a paralyzing uncertainty for parties to medical liability settlements,” said Mr. McKenna.
“MARC applauds Congressmen Murphy and Kind for introducing the SPARC Act,” said Margie O’Connor-Fitzpatrick, Vice-Chair of MARC and Senior Technical Administrator of MetLife Auto and Home. “Both Representative Murphy and Representative Kind have been true leaders in protecting Medicare beneficiaries and in leading the effort to improve the MSP program in a way that benefits all stakeholders. Following their leadership in 2012 when they sponsored the SMART Act and guided it through to enactment, we are delighted that these two Members of Congress are leading the effort again. We strongly encourage other lawmakers to follow their lead and to co-sponsor the SPARC Act,” said Ms. O’Connor-Fitzpatrick.
To define the parameters for fixing the MSP problem in Part D, MARC has advocated for the following four principles for reform:
- Access to Care. Beneficiary access to timely and appropriate care must be protected.
- The process by which PDPs reclaim what it is owed must be fair and transparent to everyone affected by medical liability settlements – employers, insurers, healthcare providers and above all, beneficiaries.
- Certainty and Simplicity. PDP claims for reimbursement from third parties must be finalized within a reasonable time.
- Fiscal Responsibility. Taxpayers deserve a CMS process for adjudicating these claims that is efficient and eliminates unnecessary waste in the Medicare system.
To achieve a more efficient solution for beneficiaries, taxpayers, and employers, MARC encourages lawmakers to join Congressmen Murphy and Kind in co-sponsoring the SPARC Act, which achieves the four principles via the following key provisions:
- Permitting PDPs to secure a clear recovery right from settling parties to recover past payments for prescription drugs covered by a later settlement, saving PDPs and the government significant funds by allowing greater recoveries faster;
- Restoring sense to the program by allowing plans to waive secondary payer provisions if costs of recovery exceed the amount to be recovered;
- Requires Centers for Medicare and Medicaid Service (CMS) within 15 days of receipt to pass settlement information to PDPs to timely coordinate benefits, and requires drug plans to instruct pharmacies to bill entities that have accepted an ongoing responsibility to pay for medical benefits, thus avoiding plans paying for drugs when others are responsible; and
- Leveraging the SMART Act expedited repayment procedures, involves Plans in the expedited repayment process, bringing finality to all involved in settling claims with beneficiaries.
When a beneficiary is injured and another party is supposed to cover their healthcare expenses – such as in a workers compensation claim – Medicare’s legal responsibility to pay is “secondary.” Unfortunately, the current Medicare Secondary Payer (MSP) policy is convoluted and confusing, creating problems and inefficiencies for beneficiaries, settling parties and taxpayers alike. That’s why MARC exists: to support commonsense reforms to fix this broken system. MARC’s membership represents virtually every sector of the MSP regulated community including attorneys, brokers, insureds, insurers, trade associations, self-insureds and third-party administrators. For more information on MARC, please visit www.MARCcoalition.com.