On Thursday, February 16, Congressman Tim Murphy (R-PA) and Congressman Ron Kind (D-WI) re-introduced the Secondary Payer Advancement, Rationalization, and Clarification Act (SPARC Act – H.R. 1122) into the US. House of Representatives. For our prior blog and a detailed overview of the SPARC Act, click here. For Congressman Tim Murphy’s press release on the SPARC Act’s re-introduction, click here.
SPARC is promulgated by the Medicare Advocacy Recovery Coalition (MARC). The key major tenets of the SPARC Act are the following:
-The SPARC Act delivers clear rules on when Part D Plans would be primary versus secondary. With non-group health plan (NGHP) being billed as primary until the claim is subject to settlement, judgment or award, the Medicare beneficiary continues to have protections in place so drugs are properly managed and contraindications are noted. The Part D plan would be primary post-settlement, judgment, or award.
-SPARC mitigates “pay and chase.” Because the Part D plan would be redirected to bill the NGHP, Part D plans would not expend unnecessary funds recouping funds improperly paid. It saves the Medicare Trust Fund by not having to pursue these recoveries.
-SPARC provides a clear right of subrogation for payments made conditionally, pre-settlement.
-Commensurate with the statute of limitations of three (3) years provided to traditional Medicare for recovery of conditional payments, Part D plans would also have a 3-year SOL.
-CMS must share MMSEA Section 111 data with Part D plans within 15 days of receipt through an online portal.
Franco Signor supports SPARC and encourages support from the industry as this legislation will provide much needed clarity into the Part D Medicare Secondary Payer recovery process.
Heather Schwartz Sanderson, Esq., MSCC, CHPE, CLMP, CMSP
Chief Legal Officer
Franco Signor LLC