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House Subcommittee Hears Testimony on Medicare SPS

Margaret Dick Tocknell, for HealthLeaders Media, June 23, 2011

With Medicare facing an uncertain financial future and seniors clamoring for steps to be taken to bolster the program's economic stability, Congress has held hearings to review how components of the program meet their statutory requirements and to hear suggestions on how the programs could be more effective.

On Wednesday morning the House Energy and Commerce Committee's subcommittee on oversight and investigation heard testimony on the Medicare Secondary Payer System. Testimony was heard from representative of the Centers for Medicare & Medicaid Services, the Government Accountability Office, businesses, law firms, consumer advocates and insurance plans.

In his opening remarks, committee chair Fred Upton (R-MI) explained that the MSPS is designed to protect Medicare funds from being spent when another payer has primary responsibility for any medical bills. He noted that because of "complex repayment and reporting requirements" the beneficiary and primary payer were often unsure who was responsible for repayment to the Medicare fund.

Upton said "there is no requirement for CMS to provide the parties with the amount due, or the amount they should set aside to cover future payments…so they can appropriately allocate and resolve these Medicare obligations…CMS is unsure when it will receive repayment. The primary payer is unsure about its bottom line, and the beneficiary, who Medicare is meant to protect, is unsure if they will receive the coverage they were promised."

Rep. Cliff Stearns (R-FL), the subcommittee chair, said the situation raised several questions, including "why can't CMS more quickly and accurately track medical costs for covered individuals?"

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