Future Medical Care Services

Whether a liability, no-fault, or workers’ compensation claim, this snapshot provides a comprehensive look at potential future medicals in play. Different from an MSA in form and function, a MCP provides critical information for parties trying to maneuver a case towards settlement. MCPs are useful for all cases in which a Life Care Plan (LCP) may be excessive (in scope and/or cost). Our MCPs contemplate both Medicare and non-Medicare medical care and treatment, including prescriptions, priced using the various nationally accepted fee schedules available. Clients obtaining MCPs from Cattie & Gonzalez can better position a case for settlement with authoritative evidence and support for future medical expenses at issue in the case.

Medicare's WCMSA Reference Guide advises that its future interests must be considered in all workers’ compensation cases, regardless of whether a case meets its arbitrary workload review threshold. As a result, a Cattie & Gonzalez WCMSA Allocation can help you by predicting what portion of a potential settlement, judgment, or award may need to be "set-aside" for future medical care related to the work comp claim. This medically-based review fully adheres with CMS pricing methodology as set forth by CMS in its WCMSA Reference Guide. Getting a WCMSA report allows you to consider Medicare's future interest in your workers' compensation case, meeting Medicare's expectations and standards.

LMSAs have been a moving target over the past decade. In furtherance of assuring compliance, Cattie & Gonzalez offers a medically-based LMSA Allocation to help parties achieve resolution of their case. While it cannot be said that LMSAs are "required" today, Medicare possesses a right of recovery for future medicals in a liability case. The MSP Act advises that Medicare will not pay medical expenses when payment has been made or can reasonable be expected to be made under a liability insurance plan. 42 U.S.C. § 1395y(b) (2)(A)(ii). An LMSA Allocation provides you with a snapshot of the maximum amount CMS may be able to claim at a later date, thereby allowing you to take Medicare’s future interests into account and assuring the Medicare beneficiary’s future entitlement to benefits.

Often, parties trying to settle a case are unable to do so due to an older MSA allocation report in the file. That report may have provided an amount which makes settlement impossible. We see that often, which is why our firm offers an MSA 2nd Opinion service. Our firm will review the previous MSA and bring it current to the present day. Laws change, regulations change, rules change. Older MSAs change too. If you have an MSA in your file that is too high and is preventing an otherwise valid settlement, ask Cattie & Gonzalez for an MSA 2nd Opinion. If we cannot provide you with a lower MSA, we will not charge you a fee.

The Cattie & Gonzalez MSA Legal Opinion advises whether a future medical obligation exists based on the specific facts of your case. If one does, it then proceeds to present the client with potential vehicles (i.e., MSAs, Medical Savings Accounts, etc.) to ensure Medicare is not billed prematurely for claim related medical expenses. It presents potential funding and administrative options. It contemplates whether Medicare should review/approve the MSA. Finally, it shares a path to obtain a judicial allocation on the merits of the case, which Medicare must respect. The MSA Legal Opinion transfers all risk away from you, and ensures you will not have to pay an additional dime above and beyond that amount recommended in the MSA Legal Opinion. Our MSA Legal Opinions avoid the potential of a CMS counter-higher, allowing parties to resolve their cases faster.

Things change. Medical needs change. Diagnostic needs change. Medications change. As time passes, you may need us to consider new or updated information. We are happy to revise our MCPs and MSAs to account for updated medical and claim related information.

Cattie & Gonzalez is able to submit our own MSA Allocation to CMS for review or an MSA Allocation you obtained from another group. Importantly, CMS will recognize one and only one representative at a time when it comes to reviewing MSAs. The first one to the CMS window, in effect, can lock out the other side. If you do choose to seek CMS review and approval of your MSA, then you must adhere to CMS’ rules and requirements. We can help you maintain as much control of that process as possible. Working with Cattie & Gonzalez to get your MSA approved by CMS assures value and compliance.

Currently, Medicare does not provide a formal review process for LMSAs. Despite that, some settling parties prefer to document their files evidencing their efforts to seek Medicare's approval of their LMSA Allocation. Our firm facilitates that for certain clients. We serve as the conduit between the settling parties and Medicare by connecting with the appropriate Medicare regional office and request its review and approval of the LMSA. While the regional office typically will not approve LMSAs, it also typically will not disagree with the LMSA. This process, in advance of any potential LMSA formal review process, allows parties to evidence efforts to obtain CMS' approval of a LMSA Allocation.

In the past, Medicare did not offer any appeals process for WCMSAs. You were stuck with the result from CMS, whether you agreed with the result or not. It's a very different scenario these days. Although we still do not have a full appeals process, CMS now offers WCMSA re-reviews and amended reviews under specific circumstances. You may have a right to an immediate re-review if CMS made an obvious mathematical error or did not consider certain documentation dated prior to the initial submission date. You may have a right to an amended review if 1) CMS has issued an approved amount at least twelve (12) but no more than seventy-two (72) months prior; 2) the case has not yet settled as of the date of the request for re- review; and 3) projected care has changed so much that the submitter’s new proposed amount would result in a 10% or $10,000 change (whichever is greater) in CMS’ previously approved amount.

Receipt of settlement proceeds, even by the representing attorney in a law firm's client trust account, may jeopardize a claimant's access to and eligibility for certain needs-based benefits like Supplemental Security Income (SSI), Medicaid, or food stamps. If the claimant wishes to protect future needs-based benefits like Medicaid, that's where Cattie & Gonzalez steps in. Our lawyers provide guidance and counsel to claimants seeking to protect future Medicaid benefits. For those wishing to protect those benefits, we may advise that they establish a Special Needs Trust (SNT). Our lawyers handle the SNT process from start to finish. We collaborate with settlement planners and attorneys nationwide to provide the best possible advice.

If the claimant wishes to protect future Medicare benefits and the question becomes one of MSA account management, you might ask whether they need help administering the MSA account and funds. If the claimant wants to hold on to the MSA funds and wishes to seek legal advice about next steps, that's where Cattie & Gonzalez steps in. Our lawyers provide guidance and counsel to claimants seeking to protect future Medicare benefits who hold onto the MSA funds and wish to self-administer their own MSA account. In addition, should Medicare deny payment of medical care related to the settled claim after exhaustion of LMSA/WCMSA funds, our lawyers will represent the claimant throughout the appeals process, including representation at hearing and request for review on appeal.