The SMART Act requires CMS to annually review the costs associated with the collection of Medicare conditional payments and set forth a threshold amount applicable to settlements, judgments, awards or other payments (TPOC amount) for which it would not seek recovery. The threshold amount for 2018 was $750. On November 15, 2018, CMS announced the same threshold will apply for 2019. Thus, as of January 1, 2019, the threshold for physical trauma-based liability TPOCs will remain at $750. The same threshold will apply to no-fault and workers’ compensation TPOCs in cases where the no-fault or workers’ compensation insurer do not otherwise have an ongoing responsibility for medicals.

In sum, if a liability, no-fault, or workers’ compensation case is settled for $750 or less, the parties are not required to report the settlement per the mandatory reporting requirements and CMS will not seek recovery of conditional payments out of the settlement, judgment, award, or other payment.

If you have any additional questions about this alert or any other Medicare questions, please feel free to contact any member of our Medicare Compliance Group.

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Shannon P. Metcalf

Michael S. Rothrock