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Medicare Set-Asides – current data says…

At the closing session at NCCI, Barry Lipton reported on their research on MSAs, research based in large part on 2200 files provided by Gould & Lamb. In 2011, CMS approved $1.1 billion of MSAs…

Key findings

  • MSA dollars account for 40% of the average proposed settlement
  • half of the MSA dollars are for prescription drugs
  • the differences between proposed and CMS-accepted MSA settlement are largely due to drugs”
  • only 20% of submissions are for claimants <50
  • 29% of submissions are for more than $300,000;
  • but, most submissions are for much lower amounts;
  • so 62% of costs are for the 29% that are for more than $200k.
  • The highest initial submission approval rate was about t50% before 12/12; during 12/12, the approval rate zoomed up to 92%.  this happened to be the same month where processing vendors changed…
  • median processing time has dropped dramatically to 41 days in Q4 2013
  • Median MSA approved amounts have been very stable at around $42,000 over the last four years.
  • recall CMS doesn’t cover off-label use of drugs, so any non-cancer claims with opioids are going to require full funding of future projected spend

The net – from my perspective, if you have an addicted claimant, CMS is going to want a lot of dollars set aside.

One thought on “Medicare Set-Asides – current data says…”

  1. What I find interesting about this is the attorney’s I work with are waiting well over a year for approval on MSA’s on many of their settlements. One party contacted our legislative representative who finally got it moving after it sat for a year or longer. They aren’t being denied…or approved. Just not moving. The numbers apparently don’t apply to Montana’s approval rate.

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Joe Paduda is the principal of Health Strategy Associates




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