How the Inflation Reduction Act Does or Doesn't Affect Your Injury Settlement.pdf

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There's been lots of hoopla about the benefits of the Inflation Reduction Act for Medicare and Affordable Care Act enrollees. This presentation addresses how the new law really affects medical expenses which figure into your injury case evaluation.

Droit

HOW THE INFLATION REDUCTION ACT
DOES OR DOESN’T
AFFECT YOUR INJURY SETTLEMENT
NSSTA FALL EDUCATION MEETING
November 3, 2022
©SnyderMediations.com

Theda (Teddy) Snyder, Esq., CSSC, mediates civil and
administrative cases throughout California. Rated
“preeminent” by Martindale Hubbell (highest rating),
she has been an attorney for more than 40 years and
has settled hundreds of cases and tried more than
100. An active author for the law practice
management industry, her most recent book is The
Lawyer’s Marketing Journal, published by
AttorneyAtWork.com. She can be reached at
TSnyder@SnyderMediations.com
© SnyderMediations.com

CASE EVALUATION AND SETTLEMENT OF INJURY CASES
REVIEW CLAIM-RELATED MEDICAL RECORDS
AND MEDICAL PAYMENT HISTORY
• DROP OUT UNIQUE PROCEDURES, e.g., SURGERIES
• PROJECT FUTURE ONGOING CARE AND MEDICATIONS INCLUDING
COLA IN ILLUSTRATION OF PRESENT VALUE
• ADD IN FUTURE UNIQUE PROCEDURES AS LUMP SUMS
©SnyderMediations.com

WHO PAID PAST EXPENSES?
WHO WILL PAY FUTURE EXPENSES?
CIVIL LITIGATION
PRIVATE INSURANCE
MEDICARE
MEDICAID
OUT-OF-POCKET
LIEN
WORKERS COMP
EMPLOYER
CARRIER
SELF-INSURED
UNAUTHORIZED
PRIVATE INSURANCE
MEDICARE
MEDICAID
LIEN
©SnyderMediations.com

CIVIL LITIGATION
COLLATERAL SOURCE RULE
(most cases)
WORKERS COMP
PRIMARY PAYER RESPONSIBILITY
(Medicare)
©SnyderMediations.com

CASE EVALUATION AND SETTLEMENT OF INJURY CASES
INSURANCE PREMIUMS WHICH WOULD NOT BE NECESSARY
BUT FOR THIS INJURY
NON-MEDICARE ELIGIBLE EXPENSES
©SnyderMediations.com

INFLATION REDUCTION ACT OF 2022
H.R.5376 - Inflation Reduction Act of 2022
Public Law No: 117-169
Signed August 16, 2022
©SnyderMediations.com

MINIMUM CORPORATE TAX ON PROFIT– 15% sort of
STOCK BUYBACK TAX – 1% of fair market value
INCREASED FUNDING FOR INTERNAL REVENUE SERVICE
CLEAN ENERGY/ CARBON EMISSIONS REDUCTION
AGRICULTURE/ FORESTRY PROVISIONS
OTHER CLIMATE RESILIENCE PROVISIONS, INCUDING USE OF DEFENSE PRODUCTION ACT
©SnyderMediations.com

MEDICARE PRESCRIPTION DRUG FUNDING REFORM
PRICE NEGOTIATION
MAXIMUM OUT-OF-POCKET CAP
PART D PREMIUM INCREASE LIMIT
AFFORDABLE CARE ACT PREMIUM INCREASE LIMIT
©SnyderMediations.com

PART D ENACTED 2003
42 U.S.C. 1395w-111 Prescription Drug Plans
(i) Noninterference.—In order to promote competition under this part and in carrying out this part, the
Secretary [of Health and Human Services]—
(1) may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors;
and
(2) may not require a particular formulary or institute a price structure for the reimbursement of covered
part D drugs.
©SnyderMediations.com

NEGOTIATION IS COMING!!
WHEN?
2024
2024
2023
2023
2025
2025
2026
©SnyderMediations.com

THEN MEDICARE CAN NEGOTIATE
THE PRICE OF DRUGS– RIGHT?
NOT EXACTLY
©SnyderMediations.com

CHOOSE FROM THE 100 MOST EXPENSIVE DRUGS
50 FROM PART B/ 50 FROM PART D
10 in 2026
15 in 2027
30 in 2028
40 in 2029 and later years
©SnyderMediations.com

EXCEPTIONS
PHARMACEUTICALS THAT HAVE BEEN MARKETED FOR 9 YEARS
BIOTECH PHARMACEUTICALS (IN CONTRAST TO CHEMICAL COMPOUNDS)
MARKETED FOR 13 YEARS
“ORPHAN” DRUGS – EXCLUSIVE FDA APPROVAL TO TREAT CERTAIN RARE
CONDITIONS (7 YEARS)
©SnyderMediations.com

$2,000 CAP ON OUT-OF-POCKET PRESCRIPTION EXPENSES
including Donut Hole
• Applies to drugs obtained through Plan D PDP or C
• Cap starts in 2025
• In 2024, no 5% co-pay in catastrophic tier
©SnyderMediations.com

CIVIL LITIGATION
COLLATERAL SOURCE RULE
EVALUATION SPECULATIVE
NEGOTIATION FLEXIBIITY
©SnyderMediations.com

SnyderMediations.com
WORKERS COMP
ONE POSSIBILITY:
MSA MONEY SLUSHES UP
NEGOTIATION FLEXIBILITY

PART D PREMIUMS
MAY BE PART OF EVALUATION –
PARTICULARLY FOR DISABLED RATHER THAN AGED
IRA LIMITS INCREASES TO 6%/YR 2023-2030
©SnyderMediations.com

©SnyderMediations.com
HEALTH INSURANCE INDUSTRY RESPONSE

AFFORDABLE CARE ACT PREMIUMS
SUBSIDIES RESTORED THROUGH 2025
THEN WHAT?
© SnyderMediations.com

SnyderMediations.com
SUBJECT FOR NEGOTIATION
REVERSIONARY TRUST?

©SnyderMediations.com
This Photo by Unknown Author is licensed under CC BY

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