SMART Limits Time Period for Medicare to Enforce MSP Liabilities
Roy Franco
July 3, 2013

SMART was signed into law by President Barack Obama on January 10, 2013.  A critical component of this legislation was to have a clear period of limitation established.  Before SMART, various cases were working themselves through the Courts with inconsistent rulings regarding the statute of limitations.  SMART changes this, so long as it is properly triggered.

Effective July 10, 2013 (six months after the legislation became law) the statute of limitations is effective.  Once an applicable plan reports in compliance with 42 U.S.C. §1395y(b)(8), then the period of limitations starts to run.  No regulations are required, but determining the starting point will require applicable plans to keep track of the dates Mandatory Insurer Reporting records are sent and acknowledged by CMS.  Assuming a successful transmission, CMS has no more than 3 years to enforce its rights under the Medicare Secondary Payer law against an applicable plan, beneficiary or entity that receives payment from an applicable plan.  

It will be interesting to see how “updates” to reporting records will be treated by the Courts.  Consequently, this author recommends being very careful in how reporting is completed.  Also, will reporting of Ongoing Responsibility for Medical (ORM) trigger the statute?  Probably not, but a record sending an ORM termination most likely will.