What are EBMSAs?

If you are a worker’s compensation attorney, then you already know about Evidence-Based Medicare Set-Asides, or EBMSAs. EBMSAs are supposedly created according to evidence-based guidelines, and designed to take into account an expected decline in medical treatment over time.

 

It’s important for attorneys to weigh the pros and cons and truly understand the effect EBMSAs can have on settlement outcomes. The creators of EBMSAs recommend them, saying they are a way to settle claims that is more reality-based because they are prepared within clinical guidelines and trends in medical research. They also suggest an EBMSA is fully compliant with MSP guidelines. However, MASSIVE’s view of EBMSAs is that they are not MSAs at all. They give little regard to the individual, injured worker. The idea of EBMSAs and ODG are sold as neutral; however, only defense organizations utilize them. The MSA vendors’ marketing material states the goal of EBMSAs is to reduce future medical costs. An EBMSA might only allow certain prescriptions; however, each one of us (or injured workers) react to medications differently. The EBMSA works in theory for just the average person. But no person is the average person. Medical care is not designed for the average person, it is designed for this injured person.

 

Additionally, EBMSA care is geared more like Medicaid-grade care than potentially necessary high-end care. Equally as important: the EBMSA only covers items that Medicare will pay for. Like any MSA: it skips non-Medicare covered medical and non-medical treatment alike.

 

These EBMSAs and Non-Submit MSAs can be problematic and will, in our estimation, burden not only the claimants, but the system as a whole. Importantly, the Centers for Medicare & Medicaid Services (CMS) has not taken a position on them; however, the methodology of EBMSAs seems to fly directly in the face of CMS’s approved methodologies. The problem EMBSAs create is: what happens if there is future care that is Medicare’s responsibility and there is not enough MSA money to pay? We think the claimant will not have coverage for these scenarios.

 

Next week, we’ll dive deeper into this topic and discuss how to protect yourself and your clients.

 

MASSIVE is the partner you can trust to answer your questions on EBMSAs and handle all your Lien Resolution and Future Medical Allocations (including MSAs). Contact our experienced and dedicated team today to learn how our services can work to get a bigger recovery for both you and your clients.