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Request for Proposals: Medicare Secondary Payer Status –The Current and Future Impact on Workers Compensation-Deadline Extended to June 17

05/22/2013 —

Request for Proposal Medicare Secondary Payer Status –The Current and Future Impact on Workers Compensation

Deadline extended to June 17

  1. Casualty Actuarial Society (CAS)
    The CAS was organized in 1914 as a professional society for the promotion of actuarial and statistical science as applied to insurance other than life insurance, such as automobile, liability other than automobile, workers compensation, fire, homeowners, commercial multiple peril, and others. Such promotion is accomplished by communication with those affected by insurance, presentation and discussion of papers, attendance at seminars and workshops, collection of a library, research and other means. The membership of the CAS includes over 5,400 actuaries employed by insurance companies, industry advisory organizations, national brokers, accounting firms, educational institutions, state insurance departments, the federal government and independent consultants.
  2. Committee on Health Care Issues
    The Committee on Health Care Issues addresses actuarial issues related to property and casualty implications of health care. The committee's charge includes furthering the development and dissemination of research and information regarding health care as they pertain to property and casualty issues; identifying topics for research and discussion; monitoring professional developments and legislative/regulatory activities; and working with continuing education and program committees in sponsoring panels, seminars, and other public forums on health care issues. The Committee on Health Care Issues will sponsor the research to be conducted under this RFP on behalf of the CAS.
  3. CAS Interest in the Subject
    Since its inception in 1914, the Casualty Actuarial Society has been active in health issues associated with social insurance and workers compensation and has, of course, also been involved in other property and casualty lines with health care components. This research RFP allows the CAS to provide a key voice on a broad-ranging and important issue that connects the healthcare and workers compensation marketplaces.
  4. Research Problem Description

    The Committee is requesting research on the potential future financial impact to the property and casualty insurance and self-insurance industry of Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (“MMSEA”).

    As background, this section of the MMSEA requires commercial insurers and self-insured entities to report claimants/plaintiffs that are potentially Medicare-eligible directly to the Centers for Medicare and Medicaid Services (“CMS”). Reporting began for workers compensation insurers on January 1, 2010, and for liability insurers on January 1, 2012. By law, Medicare has been a secondary payer since its inception in 1965. Section 111 has not changed Medicare’s status as a secondary payer, but it has changed the way in which Medicare can now enforce that status.

    The research should provide pertinent background on the relevant history, statutes and rules, and recent changes in the healthcare industry that may have accelerated these changes. This should consider CMS’s historical position regarding Medicare Set Asides, as applicable. The research should formulate a methodology for estimating the future cost differential between Medicare and the commercial insurance and self-insurance marketplace for the affected property and casualty coverages. This would likely include estimates of the impact on existing open claim inventories, the potential financial impact of re-opened claims, and future reported claims. Lastly, changes in claims administration costs should also be considered.

    The Committee expects the research will focus on workers compensation coverage, but we welcome insight related to liability coverages that are also affected (e.g., auto liability, general liability).

    The research should be presented in a way that allows for self-insured entities and insurance carriers to better estimate and manage the estimated financial impact.

    The research for this project will be performed under contract and funded by the CAS. It is expected that the researcher(s) will work with representatives of the Committee on the specific design of the project.

  5. Project Requirements

    The research paper should survey actuarial as well as other literature for any research relating to these issues and include a bibliography of such research.

    The estimation of the impact of this new legislation should be presented in a form that a practicing actuary can implement in a practical manner solely from reading the research paper.

  6. Proposal Requirements

    Proposals should include a clear outline of the proposed research paper and be accompanied by the resumes of the author(s), indicating how their background, education, and experience bear on their qualifications to undertake the research.

    Receipt of proposals will be acknowledged for each submission. Interested authors should submit their proposals and any questions electronically to Cheri Widowski, CAS Research Manager, at cwidowski@casact.org.

    The contract will be awarded by the CAS to the respondent who, in the judgment of the Committee on Health Care Issues and entirely on the basis of his or her written proposal, is best able to perform the work as specified herein.

    If the Committee determines that no proposal meets the requirements of the RFP, then no contract will be awarded. Respondents not awarded the contract will be so informed shortly thereafter.

    The proposals will be reviewed by members of a subcommittee of the Committee on Health Issues. The current membership of the Committee includes:

    • Stephen R. DiCenso (Chairperson)
      Anne Marlene Petrides (Vice Chairperson)
      Edward G. Bradford
      Anthony R. Bustillo
      Christian J. Coleianne
      Michael L. DeMattei
      Kevin M. Dyke
      Derek A. Jones
      Glen Alan Leibowitz
      David M. Patterson
      Manalur S. Sandilya
      Debbie Schwab
      Clista E. Sheker
      Alfred O. Weller
  7. Schedule
    • Proposal deadline – June 17, 2013
      Committee selection decision – July 17, 2013
      Research paper due – October 17, 2013
  8. Compensation
    A maximum total of $20,000 is available to be awarded to one or more researchers. Payment of award(s) will be contingent upon delivery of an acceptable research product.
  9. Presentation, Ownership and Publication of Report

    If asked, the researcher(s) agree to be available to present the report at a CAS meeting or seminar. If travel is required, reasonable expenses will be paid in addition to the compensation provided in Section 8.

    As a condition of selection, the CAS requires that all right, title, and interest, including copyright and patent, in and to the report be owned by the CAS. The selected researcher must sign a formal Agreement that assigns all such rights to the CAS. Of course, in any publication of the report, the researcher will receive appropriate credit. The CAS may publish the report in any CAS publication, including electronic versions such as on its Web site

  10. Research Agreement

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