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Thread: Florida MSA

  1. #1
    Join Date
    Feb 2012
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    Default Florida MSA

    In the state of florida when a medicare set aside has been done , how long is it good for ? By law how often does it have to be redone ? Can a W/Comp lawyer legally tell you that you have to agree on a settalment figure before they will do another MSA ?

  2. #2
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    Feb 2007
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    Default Re: Florida MSA

    The CMS/Medicare reviews/approved a MSA once... unless there is a significant change in your condition, IE. 2 years down the line, CMS will not review another proposal.
    Can a W/Comp lawyer legally tell you that you have to agree on a settalment figure before they will do another MSA ?
    Drop the word "legally"... not everything is about "legally/illegally"... yes, the DA can tell you whatever they want... that does not mean it's right wrong or indifferent.

    Not entirely sure what you are asking here... care to elaborate?

  3. #3
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    Feb 2012
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    Default Re: Florida MSA

    we have not reached a settalment agreement , cms has not reviewed one yet but the set aside has been done twice with the last one being two years old . This is why i was asking how long the are good for ? I have been told they are only good for a year and that w/c does not want to pay for another one unless a figure is agreed to . My point is , if you dont know what the new medicare set aside is how can know what a good settalment figure be ... Also If both sides agree to a settalment why would I have to wait up to a year to recieve lump sum payment

  4. #4
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    Default Re: Florida MSA

    Any MSA is good for one year. When was your last one done? You can agree to a settlement with the contigency that if the MSA comes back at a higher rate then the carrier is responsible to pay the difference.

  5. #5
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    Default Re: Florida MSA

    If the MSA proposal hasn't been submitted to CMS/Medicare for review/approval...the MSA vendor or carrier can do one every day if they want to pay for it. There is no legal timeframe or expiration date.

    Once a party submits the proposal...then only that party may resubmit to CMS for recondsideration. IE, if the IW submits the proposal, the carrier nor vendor may resubmit. (I'll have to look for the authority on that...sorry I lost my "bookmark" when upgrading to IE8)

  6. #6
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    Default Re: Florida MSA

    So if i'm understanding ADJ 's reply , the MSA is good for a year but there isn't a law making the carrier redo the MSA every year ?

  7. #7
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    Default Re: Florida MSA

    the MSA is good for a year but there isn't a law making the carrier redo the MSA every year ?
    There are NO laws that govern MSA's.. like I said, if the carrier wants to pay to have one done, they can do it every day. There isn't much point in redoing a proposal if they aren't happy with the numbers... until there is a change in your condition.
    Once the MSA proposal is submitted to CMS... it does not change until/unless there is a significant change in your condition... based on the past 2 years of medical provided, a new proposal may be done, and submitted to CMS for review...by the orginial submitter.

  8. #8
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    Default Re: Florida MSA

    What we have been told here in Florida is that if the MSA is over one year old then a new one must be done for CMS approval. This was a directive received from CMS. We submitted more than one MSA that was over a year old and CMS rejected them. Not sure what the actual statute says since it is rather cumbersome but this is the directive we were given.

  9. #9
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    Feb 2012
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    Default Re: Florida MSA

    Thank You both for your time , it has been helpful ...

  10. #10
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    Default Re: Florida MSA

    Quote Quoting ADJ View Post
    What we have been told here in Florida is that if the MSA is over one year old then a new one must be done for CMS approval. This was a directive received from CMS. We submitted more than one MSA that was over a year old and CMS rejected them. Not sure what the actual statute says since it is rather cumbersome but this is the directive we were given.
    Yup...that would be true on the orginial proposal... a MSA a year old would be "stale"...if it's not agreeable to the parties, and not submitted to CMS....a new one would be necessary... updated to the IW's condition.

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