2022: LMSA Pushed to February, $750 Threshold Remains

Last Updated: 22 Dec 2021

Author: Michelle Allan

It’s beginning to look a lot like LMSA rules aren’t happening in 2021. So if this was your wish from Santa, you must be on The Naughty List. This week, the Office of Information and Regulatory Affairs (OIRA) updated the timeframe from October 2021 to February of 2022. And for all of the “Nice” primary payers, beneficiaries, attorneys and insurance professionals, CMS kept its $750 minimum recovery threshold in place for the coming year.

On December 15, 2021, CMS disseminated its annual alert for Computation of Annual Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, Judgments, Awards, or Other Payments for 2022. As per the SMART Act of 2010, this low dollar threshold renews on January 1, 2022, such that settlements of $750 or less do not need to be reported and Medicare’s conditional payment amount related to these cases would not need to be reimbursed.

Rulemaking believed to promulgate formality to Liability and No-Fault Medicare Set-Asides has been on the radar for several of years now, with no hint of detail.

The Abstract states that the rule “would clarify existing Medicare Secondary Payer (MSP) obligations associated with future medical items services related to liability insurance (including self-insurance), no fault insurance, and workers’ compensation settlements, judgments, awards, or other payments. This proposed rule would also remove obsolete regulations.”

Previous iterations of the Abstract used language such as:

“Currently, Medicare does not provide its beneficiaries with guidance to help them make choices regarding their future medical care expenses when they receive automobile and liability insurance (including self-insurance), no fault insurance, and workers’ compensation settlements, judgements, awards, or payments, and need to satisfy their Medicare Secondary Payer (MSP) obligations.”


 “This proposed rule would ensure that beneficiaries are making the best healthcare choices possible by providing them and their representatives with the opportunity to select an option for meeting future medical obligations that fits their individual circumstances, while also protecting the Medicare Trust Fund.”

What has not changed in the Abstract is Medicare’s suggestion that any proposed rule will be voluntary in nature, although the “Significant” status broaches the possibility that there could be a policy concern or legal mandate involved.

Unsure of whether to report a claim? Concerned with Medicare Conditional Payment obligations? Wondering how to protect entitlements in liability or no-fault matters? Better not pout, better not cry. Just message an Allan Koba Compliance Solutions professional at Info@allankoba.com.



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