Page 1 Recording of this session via any media type is strictly prohibited. Page 1 SMART Medicare Update Roy A. Franco Chief Legal Officer / Franco Signor LLC & Barry Dillard Manager, Guest Claims / Walt Disney World Resort

Page 2 Recording of this session via any media type is strictly prohibited. Roy A. Franco Chief Legal Officer Franco Signor LLC Over the past two decades, Roy A Franco has emerged as one of the principal architects of policies and practices that define the world of Medicare Secondary Payer (MSP) compliance. The Medicare Advocacy Recovery Coalition (MARC) became the chosen vehicle for that reform effort. Founded in 2008 by Mr. Franco and other persons interested in Medicare policy, its membership comprises most sectors of the MSP-regulated community, including plaintiffs, defense attorneys, brokers, trade associations, and third part administrators. The coalition’s primary mission is to advocate for MSP on behalf of Medicare beneficiaries and companies. Its major achievement to date is the Strengthening Medicare and Repaying Taxpayers (SMART) law of Drawing on his wealth of experience, in 2011 Roy Franco and Jeff Signor founded Franco Signor LLC, which specializes in Medicare compliance.

Page 3 Recording of this session via any media type is strictly prohibited. Barry Dillard Manager, Guest Claims Walt Disney World Resort Barry Dillard is the Manager of the Walt Disney World Guest Claims Department. The Guest Claims team is responsible for the handling of Guest bodily injury and property damage liability claims for the Walt Disney World Resort, Disney’s Vero Beach Resort and Disney’s Hilton Head Island Resort. Barry has 24 years of experience in the insurance industry, the last 16 years with Disney. His career began with Aetna Casualty & Surety Company as a Liability Claims Representative.

Page 4 Recording of this session via any media type is strictly prohibited. The ABC’s of SMART  Amended the Medicare Secondary Payer Act  Broad-based Support MARC AAJ RIMS DRI FMI  Regulation is Required for Certain Aspects of Law  Applies to all LOB, Unless Otherwise Stated

Page 5 Recording of this session via any media type is strictly prohibited. Medicare Compliance Parts  Past or “Reimbursement” of “conditional payments” See 42 USC 1395y(b)(2)(B)(ii)  Present or “Reporting” 42 USC 1395y(b)(8) and 42 CFR §  Future or “Protecting ” Medicare’s Interest because “payment [by a primary plan] can reasonably be expected to be made” 42 USC 1395y(b)(2)(A)(ii)

Page 6 Recording of this session via any media type is strictly prohibited. SMART Key Provisions  Section 201: New CP Demand & Appeal Rights  Section 202: Sets Annual MSP Threshold  Section 203: Softens §111 MMSEA Penalties  Section 204: Prohibits Use of SSN and HICN  Section 205: Adds 3 Year Statue of Limitations

Page 7 Recording of this session via any media type is strictly prohibited. SMART CP Demand  Interim Final Rule - 42 CFR § (IFR)  Proposed Process: Beneficiary Parties notify BCRC 185 days before S/J/A BCRC has 65 days to process CP, but can add 30 days Download not valid, unless refreshed (before 12/31/2015) 3 days prior to S/J/A Dispute process in tact Still requires BCRC Demand Letter

Page 8 Recording of this session via any media type is strictly prohibited. Status on Other SMART Rules  Appeal Right – Request for Comment Closed 2/25/2014  Annual MSP Threshold – Published 2/20/2014  MMSEA Penalties ANPRM for Safe Harbors Closed 2/7/2014 OIG Work Plan 2014 to develop Rules  Prohibition of SSN and HICN – 1/1/2016 Statute of Limitations – 7/1/2013 Effective 7/20/2013

Page 9 Recording of this session via any media type is strictly prohibited. What SMART Did Not Address  Future Medicals  Medicare Advantage & Part D  Streamline Data Reporting

Page 10 Recording of this session via any media type is strictly prohibited. MSP Horizon  Future Medicals for Liability Claims Pending Regulation – 42 CFR  False Claims Act and MSP Relationship  Medicaid Reporting

Page 11 Recording of this session via any media type is strictly prohibited. Questions, Final Comments and Contact Information Roy Franco Tel:

Page 12 Recording of this session via any media type is strictly prohibited. KEEP THIS SLIDE FOR EVALUATION INFORMATION/MOBILE APP ETC. Please complete the survey on the RIMS14 mobile application.