The MARC Monitor: November 2017

Congress has shifted its full focus to tax reform as leadership scrambles to pass an overhaul of the nation’s code before the end of the year. Following several days of around-the-clock negotiations and speculation, The House GOP released the legislative text for H.R. 1 – The Tax Cuts and Jobs Act (TCJA) (textsection-by-section), signaling a significant step forward in the GOP’s push for a major overhaul of the nation’s tax code. The bill passed out of the House Ways and Means Committee last week, and heads to the House floor for debate and final passage by the end of this week, The Senate’s version of TCJA is slated to be marked up this week in the Finance Committee. 


Following the resignation of lead SPARC act sponsor Tim Murphy (R-PA), MARC is working to improve and reintroduce the SPARC Act before the end of the year. While we’ve seen momentum building for the SPARC Act, the opportunity to reintroduce the bill allows for crucial changes to be made to further improve federal secondary payer policy. MARC has already generated hundreds of comments to Members of Congress through our Action Center, and will continue to encourage stakeholders to voice their support for the bill. 

An update on all the issues we’re following this month is included below. For more info, follow us on social media and visit us at

Until next month,

The MARC Team

Morning Consult: Medicaid Third Party Liability and the Healthy Kids Act – It’s Time 

MARC Coalition’s Greg McKenna and David Farber stress the need for improving the states’ Medicaid “third party liability” programs in a Morning Consult Op-Ed. In the Op-Ed, the authors outline the documented problems with the TPL system. “Unfortunately, implementation (of Medicaid TPL) has not gone smoothly,” write McKenna and Farber. “In 2013, the Office of Inspector General studied the gaps in Medicaid TPL programs, documenting over $4.1 billion “left on the table” by states in their failure to collect available funds from existing coverage (such as group health and Medicare). The Government Accountability Office has also documented problems with the TPL system, focusing on how health insurers and pharmacy benefit managers obstructed states from identifying which Medicaid beneficiaries had alternative primary health insurance”

The authors advocate for Congress to focus on the common-sense reform through Medicaid third party liability (TPL) provisions of the Healthy Kids Act of 2017. These provisions would focus on the data and follow the money by working to streamline TPL recoveries from Medicare and group health policies. “Legislation introduced by Rep. Michael Burgess (R-Texas) (H.R. 938) takes on the issues to better coordinate coverage between Medicaid and group health insurers. Fortunately, the Energy & Commerce Committee included the legislation in the recent Healthy Kids Act. As representatives of the MARC Coalition, we are pleased to support this important legislation, and urge Congress to enact this important improvement to the Medicaid TPL process.”

Click here to read the Op-Ed.

House Passes Provision Extending Murray-Ryan Delay

We are pleased to report that on November 2, 2017, the House passed the HEALTHY KIDS Act of 2017 (textsummary) which included two important provisions for non-group health plans. First, the legislation contained an important extension of the deferral of the Murray-Ryan Medicaid provisions that Congress has twice before delayed, but which could have gone into effect on October 1. The provision, which applies retroactive to October 1, would add another two year deferral of the ill-advised provision affecting Medicaid recovery rights in settlement situations. Second, the legislation included an important clarification of the definition of a “responsible third party” limiting the provision to group health plans consistent with Congressional intent. Thanks to all MARC members who advocated on these issues over the past months.   

We are also pleased to report that after meetings with Senate Finance Committee staff, the Senate’s version of the extension of the Murray-Ryan delay has been included in the draft of the Senate “Extenders” Package (section 114). The package features a collection of health care and tax provisions that normally sunset in September or December, and which Congress wants to extend. MARC expects this package —along with to be combined into a comprehensive package for passage in early December. 

It is expected that the Senate may introduce a mirror version of the original Medicaid Third Party Liability bill introduced in the House by Rep. Michael Burgess (R-TX). However, MARC has been advised that the Senate version might not include the helpful amendments we were able to secure as the House version was include in the House CHIP bill. The Committee is aware of MARC’s concerns and we will continue to work with Senate staff to ensure similar clarifying text is included in the Senate bill as was the case in the House. We will keep you posted as developments unfold.

LMSA Update: CMS Considering an Expansion of Medicare Set-Aside Arrangements

Following a meeting with MARC Representatives in which we advised CMS that no stakeholder engagement had been conducted by agency staff on LMSA issues, CMS released a statement to its email distribution list reiterating that it will pursue such engagement before undertaking further steps on possibly expanding its voluntary Medicare Set-Aside Arrangements (MSA) review process to include: (1) liability insurance (including self-insurance) and; (2) no-fault insurance MSA amounts. “

The Centers for Medicare and Medicaid Services (CMS) continues to consider expanding its voluntary Medicare Set-Aside Arrangements (MSA) review process to include liability insurance (including self-insurance) and no-fault insurance MSA amounts. CMS will work closely with the stakeholder community to identify how best to implement this potential expansion of voluntary MSA reviews. Please continue to monitor for updates and announcements of town hall meetings in the near future.”

Tell Us Your Story

As part of our efforts to generate stories from individuals who have faced real-world complications or disruptions in care related to federal MSP laws, MARC has developed a new webpage where individuals can share their story. The information submitted will remain confidential, as users are not required to include their name or email address with their submission — only a brief comment is required.

Among the questions prompted to site visitors:

  • Have you struggled to have Medicare claims paid after settling a workers compensation case?
  • Did you get reimbursed after an accident, then struggle with Medicare on a future claim? 
  • Have you been denied coverage by Medicare after being reimbursed from an automobile injury?

We encourage you to invite individuals to fill out the form by visiting:

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