By Marty Cassavoy, Vice President of Medicare Secondary Payer Compliance
Patricia Kent RN and JD, Medicare Secondary Payer Compliance Counsel
The Industrial Commission of Arizona released updated advisory guidance for full and final settlements. The document provides a list of suggested Best Practices for Practitioners when resolving claims full and final in the State of Arizona.
The Best Practices break down into four categories, the largest of which concerns filing full and final settlements. The document can be found here. The suggested filing practices are the most impactful of the four categories and are summarized as follows:
The agreement “should include a description of the injured worker’s medical conditions that have been identified and contemplated at the time of the Full and Final Settlement Agreement.”
The parties should include a disclosure of the medical and indemnity components to the full and final settlement including:
- “Written disclosure of the following: (1) reasonable anticipated future medical, surgical, and hospital benefits relating to the claim; (2) the projected cost of those benefits; (3) an explanation of how those projected costs were determined; and (4) the amount of the settlement that represents the settlement of future medical, surgical and hospital benefits;”
The full and final settlement should include written attestations from the injured worker as follows:
- “The injured worker understands that monies received for future medical treatment associated with an industrial injury should be set aside to ensure that the costs of such treatment will be paid. See A.R.S. § 23-941.01(C)(4). Note: This attestation should include a statement about the injured worker’s understanding of the need to set aside monies for future medical treatment and a statement explaining how the injured worker plans to set aside monies for future medical treatment.”
The full and final settlement should include written attestations from all parties as follows:
- “The parties have considered and taken reasonable steps to protect the interests of Medicare, Medicaid, the Indian Health Service, and the United States Department of Veterans Affairs, including establishing a Medicare savings account or a Workers’ Compensation Medicare Set-Aside Agreement (“WCMSA”), if appropriate. See A.R.S. § 23-941.01(C)(5).
Note: This attestation should include a discussion of all steps taken by the parties to protect the interests of Medicare, Medicaid, the Indian Health Service, and the United States Department of Veterans Affairs.”
Arizona’s expansion into full and final workers’ compensation settlements offers a unique opportunity to resolve claims fully and completely, and not available previously. With the publication of the Best Practices document, the Industrial Commission makes clear that it expects parties to have a clear understanding of future medical cost. Regardless of whether an individual is entitled to Medicare or not, the Commission recommends that every settlement indicate the projected cost of reasonable future medical care. In addition, the parties must attest that they have “considered and taken reasonable steps to protect the interests of Medicare.”
Parties taking advantage of the new Arizona law should be aware of a basic formula for resolving claims where post-settlement medical care is a consideration, as follows:
- Whenever a Full and Final Settlement requires post-settlement medical care, parties should consider the viability of obtaining a future medical care allocation such as a Medical Cost Projection in order to document “reasonable anticipated future medical” care.
- If an individual is on Medicare or has a reasonable expectation of Medicare enrollment within 30 months, the Commission’s best practice directs parties to provide a written attestation that they have “taken reasonable steps to protect the interests of Medicare . . . including establishing a medical savings account or Workers’ Compensation Medicare Set-Aside Agreement”.
- Parties are further directed to ensure that they have “taken reasonable steps to satisfy any identified medical liens.”
ExamWorks Clinical Solutions offers a full range of options to accomplish any or all of these best practices. As the industry leader in Medicare and Medicaid Secondary Payer Compliance, we are well- placed to assist on facilitating full and final settlements in the Arizona. Our consultative and comprehensive medical/legal evaluations take into account all aspects of a claim and ensure that parties receive artfully tailored recommendations that ensure prompt resolution of the underlying workers’ compensation claim.
Our team of lawyers is following these important changes to Arizona law and will provide further updates if and as required.
About Marty Cassavoy
Marty Cassavoy is the Vice President of MSP Compliance at ExamWorks Clinical Solutions. Marty and his team develop solutions to challenges in all areas of Medicare Secondary Payer compliance and across all insurance types. An attorney licensed to practice law in Massachusetts, Marty works in ExamWorks’ Woburn, Massachusetts office and can be reached at 781-517-8085 or firstname.lastname@example.org.
About Patricia Kent
Patricia Kent is currently a Medicare Secondary Payer Compliance Counsel at ExamWorks Clinical Solutions. Patricia worked as a Registered Nurse for 20 years. In 2002, she graduated from Stetson College of Law with a JD and has specialized in Medicare Secondary Payer compliance for the last decade. Patricia is a frequent lecturer and has been recognized in the Federal Courts as an expert witness in the area of Medicare Secondary Payer compliance. She is a member of the Florida Bar. Patricia can be reached at 678-256-5048 or email@example.com.