Medicare Suggests LMSAs and NFMSAs are on the Horizon. Again.

Medicare via HHS/CMS has once again put us on notice that Medicare Set-Asides may expand to liability and no-fault scenarios with LMSAs and NFMSAs. It recently released a Notice of Proposed Rule Making with a due date of February 2022. You can find the NPRM here.


Could that mean CMS will finally create rules and guidance for LMSAs? Maybe.


Regardless, Medicare is legally forbidden from paying for case-related care until settlement funds are exhausted. See 42 USC 1395y(b)(2)(A):

“Payment under this subchapter may not be made … with respect to any item or service to the extent that – (i) payment has been made, or can reasonably be expected to be made, with respect to the item or service as required under paragraph (1), or (ii) payment has been made… under a workmen’s compensation law or … under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insurance.”


We could be weeks away from guidance. Finally. Check back for updates in February.