Over the past year, I’ve been able to learn a lot about the Medicare Advocacy Recovery Coalition (MARC), an organization consisting of representatives from all over the workers’ comp industry – carriers, TPAs, comp service providers, attorneys, employers, and more.
Greg McKenna, Vice President and Counsel for Gallagher Bassett Services, invited me to attend a MARC meeting at the WCI Conference in Florida last year. To say I was impressed would be an understatement. This group of men and women – who on most days are competing against each other for business – come together on a regular basis to advocate for the improvement of MSP programs – something that affects us all.
The fact that the coalition even exists is amazing, and attests to the importance of their mission (see below). I sincerely hope this brief article will shed light on this great organization, and that more individuals and organizations in our industry will be intersted in joining their cause.
When was MARC founded, and who were your Founders?
The Medicare Advocacy Recovery Coalition (MARC) was formed in September of 2008 by a group of industry leaders who saw a critical need to improve the MSP system.
Who are the current leaders of MARC? Please tell us their names, current positions, what organizations they work for.
Michele Adams, MARC Chair, The Walt Disney Company
Greg McKenna, MARC Vice Chair, Gallagher Bassett Services, Inc.
Margie O’Connor-Fitzpatrick, MARC Secretary/Treasurer, MET Life, Inc.
Roy Franco, MARC Past Co-Chair, Safeway, Inc.
Susan Murdock, MARC Administrative Director
Who are your members? If there are too many to list here, tell us what types of organizations or individuals are members?
MARC’s membership represents virtually every sector of the MSP regulated community, including plaintiffs and defense attorneys, brokers, insureds, insurance and trade associations, self-insureds and third-party administrators. Members include Allstate, Burns White, LLC, Defense Research Institute, Food Marketing Institute, Franco Signor, LLC, Gallagher Bassett Services, Inc., GlaxoSmithKline, Met Life, Inc., Nasco, Property Casualty Insurers Association of America, Safety National, Sedgwick Claims Management, and The Walt Disney Company, as well as many others. Although each of the MARC member organizations have their own business initiatives in the secondary payer community, they clearly understand the importance of speaking as a “unified voice” on Capitol Hill and with the various government agencies to reform the Secondary Payer programs and policies.
Related to the last question, how many members do you have, and are you growing?
Currently MARC has 36 member organizations. A member organization is afforded the opportunity to help shape Coalition policy positions on secondary payer reform. MARC’s success, in large part, is a result of the Coalition membership maintaining a focused policy agenda, operating efficiently as a virtual organization, and most importantly creating a culture of building consensus on secondary payer issues.
What is the main purpose, goal, or mission of MARC?
The Medicare Advocacy Recovery Coalition (MARC) is a national Coalition advocating for the improvement of the Medicare and Medicaid Secondary Payer (MSP) programs. Since its inception in 2008, MARC has maintained a focused policy agenda advocating for secondary payer reform on three fronts — before Congress, before federal agencies, and before the courts.
The Coalition has been successful in collaborating and developing strategic alliances with beneficiaries, affected companies, and a wide range of other stakeholders, with the goal of working effectively with Congress and government agencies to implement MSP reforms that will improve the process for all.
MARC is and continues to be the leading voice in communicating with Congress, the Executive Branch, and the White House on “Section 111” reporting issues. MARC has met and educated Congressional Leaders in both the House and Senate, as well as met with officials in the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, and the White House on MSP issues.
What is your official Mission Statement?
Together, the MARC Coalition strives to ensure that all stakeholders affected by the federal Secondary Payer laws are able to work within an efficient and comprehensive statutory and regulatory regime to provide timely resolution of disputes and the fair reimbursement of claims involving secondary payer issues. We will achieve this through:
- Facilitation of national-level coordination, collaboration, and communication among the member organizations;
- Formulation of policy recommendations to improve Medicare Secondary Payer reimbursement and recovery procedures;
- Ensuring Medicare beneficiaries receive coordinated and appropriate coverage for claims involving secondary payer concerns;
- Protection of the Medicare Trust Fund by facilitating timely and appropriate reimbursement of funds owed under the law; and
- Development and implementation of legislative and regulatory improvements to ensure that the secondary payer program works effectively, efficiently and economically
Who are the primary beneficiaries of the work you do? And why.
Medicare & Medicare Beneficiaries. The Medicare Secondary Payer (MSP) law, enacted by Congress in 1980, establishes “who pays first” when a Medicare beneficiary requires treatment and a third party may be responsible for paying for certain health care costs. In such cases, the third party pays “first”, and Medicare becomes ‘secondary.” MSP issues arise when a beneficiary has private health insurance or a third party is responsible to pay for certain health care costs, such as in a settlement or through workers compensation or no-fault (auto) insurance. These third-party non-group payers are known as “non-group health” (NGHP) claims.
For many years, the MSP laws and regulations were poorly understood and CMS rarely enforced NGHP claims. In 2007, Congress amended the law requiring companies settling cases to report every settlement, judgment, award, or other payment made to a beneficiary to the Centers for Medicare and Medicaid Services (CMS). Failure to report properly was subject to a penalty of $1000 per day per claim. The system for reporting and repaying claims to Medicare, however, was broken. As a result, settlements were unnecessarily delayed, which wasted government, beneficiary, and stakeholder resources. Beneficiaries’ claims against third parties became difficult, if not impossible, to settle. All parties were left confused and frustrated.
Other inefficient rules plagued the system, including: (1) requirements that beneficiaries provide their Social Security Numbers (SSNs) to parties against whom they were pursuing a claim in order to settle; (2) a lack of safe harbors for good-faith efforts to report properly; and (3) low-dollar recovery demands that cost the government more to process than it could collect.
In response, the 112th Congress passed the SMART Act to remedy the major problems within MSP. The SMART Act strengthens Medicare, protects beneficiaries, and improves the MSP process by enabling all parties to settle claims quickly and speed repayments to Medicare.
- The SMART Act provides a more-affordable and less-intrusive MSP system that protects beneficiaries and the Medicare Trust Fund while minimizing waste among judicial and other resources.
- The SMART Act does not needlessly confuse parties trying to settle a beneficiary’s injury claim.
- The SMART Act empowers Medicare to provide settling parties the amount of their repayment obligation during the settlement process, allowing taxpayers to settle quicker and repay Medicare faster.
- The SMART Act increases Medicare’s efficiency by ensuring the government does not spend more money pursuing a MSP claim than it will actually recover.
- The SMART Act include safe-harbors to protect stake holders that make good faith efforts to comply with Medicare’s complex MSP reporting process and safeguards Medicare beneficiaries by eliminating the required use of their SSNs in the MSP reporting process.
What are the main accomplishments MARC has made in the past year?
This past year, was marked by numerous Coalition successes, including:
- Implementing a settlement “threshold” below which settlements are exempt from MSP requirements, helping the members avoid the cost of navigating the system for low dollar settlements.
- Working with CMS to abandon using the full SSNs, in order to “report” settlements with beneficiaries.
- Working direct with CMS representatives, making valuable recommendations on improvements to the functionality of the MSP Recovery Portal.
- Successfully advocating for withdrawal of CMS Rulemaking to regulate “future medicals” in liability settlements, which would have negatively impacted ability to settle cases.
- Succeeding in delaying for two years impending change in the Medicaid secondary payer law (Murray-Ryan bill) that would have increased Medicaid recoveries from settlements.
What are your goals for the next 12 months?
- SMART Act Implementation
- Issues related to Medicare Advantage (Part C) Plans and Medicare Prescription Drug (Part D) Plans
- Medicaid Secondary Payer
- Future Medicals in Liability Cases
- Federal Presumption of Allocation in Secondary Payer Cases
- Treasury Offset Program (TOP)
What is the highest priority you are working on right now?
The MARC Coalition is also committed to working with Centers for Medicare and Medicaid Services and the Congress to ensure that the SMART Act is implemented timely, and correct.
The Coalition remains committed to engagement in the important legal cases to ensure that courts are informed about the MSP process and that beneficiaries, the Trust Fund, and all stakeholders in the MSP process are fairly treated under law.
If our readers are interested in learning more about MARC, who should they contact?
MARC Administrative Director
1700 Pennsylvania Avenue, 10th Floor
Washington, DC 20006