Notice of reimbursement arrangement (NORA) - Medicare Compensation Recovery 011-15030040

A reimbursement arrangement is:

• an agreement in writing
• an order by a court or compensation authority, or
• a decision by a person or representative body that the notifiable person is liable to pay for related medical services and care costs as they are incurred

A reimbursement arrangement does not include payments where there has been a fixed amount awarded for damages exceeding $5,000.

Under section 13 of the Health and Other Services (Compensation) Act 1995 (HOSC Act), a compensation payer or their representative must tell the agency:

• if 6 months has passed from the date the claim was made by the injured person to the date the reimbursement arrangement is made
• within 28 days after the arrangement was made, and
• on the Medicare Compensation Recovery Notice of reimbursement arrangement form (MO027), or
• in writing

See Notifiable and not notifiable claims - Medicare Compensation Recovery.

If the reimbursement arrangement is made within 6 months of the date the claim was made by the injured person, the claim is not notifiable.

When the Agency gets notification within 6 months of the date the claim is made, MCRS will issue the letter You do not need to tell us about the reimbursement arrangement (Z2797) to the customer.

The Z2797 letter tells customers that:

• the claim is not notifiable
• any payment received will be returned, and
• details of how to get a Medicare claims history

Where the compensation payer appearing on the notification is on the Bulk Payment Agreement (BPA) list:

• register the claim as a provisional work item number (WIN) in MCRS, and
• escalate to Programme Management. See Escalations and case notes - Medicare Compensation Recovery.

If the BPA applies to the claim, a specified amount will be payable instead of a NOC. See Process Correspondence - Medicare Compensation Recovery for how to assess if a BPA applies to the claim.

The Process page contains details about what is a valid NORA arrangement and supporting documentation.

The References page contains a link to the legislation.

The Resources page contains a link to the MO027 form.

The NORA must include the below details:

• injured person's name, address, and date of birth
• date of injury or illness
• nature of the injury or illness the injured person suffered (for example, broken arm)
• compensation payer’s name and address details
• date the claim was lodged
• date the reimbursement arrangement was made
• full name and signature of the compensation payer or compensation payer’s solicitor or agent

If Date of lodgement of the claim and/or date the reimbursement arrangement is missing from the notice, Service Officers:

• can get this details by telephone (or an email or letter) from the:
• compensation payer
• agent, or
• solicitor
• must leave a case note documenting how the missing details was gotten

All other details must be supplied in writing for the notice to be considered valid.

The document will be considered valid and complete if the details listed above has not been provided on the notice or form but can be gotten from supporting documentation such as:

• appeal decision documents, for example, Administrative Review Tribunal (ART) determination
• complying agreement
• tribunal document, for example - certificate of determination

Where there is missing or incomplete details on the Medicare Compensation Recovery Notice of reimbursement arrangement form (MO027), See Issue correspondence for missing information.

The Resources page contains a link to the MO027 form.

Under section 29(4) of the HOSC Act, if a valid NORA is not received by the agency within 28 days after the arrangement was made, the compensation payer is liable to repay any debts identified in the NOC. MCRS will issue a Medicare Compensation Recovery letter to the compensation payer.

If a reimbursement arrangement is made, the agency recovers all Medicare benefits and care costs that relate to the injury:

• before the reimbursement arrangement starts, if more than 6 months have passed since the compensation claim was made
• from the date of injury/illness to the date the reimbursement arrangement is made
• if the Administrative Review Tribunal (ART) or other tribunal, determine medical expenses and care costs must be reimbursed to the injured person and impose a specified liability period
• if all or part of the medical expenses have not already been reimbursed to the injured person

Note: the agency does not need to be notified of any ongoing medical costs once the arrangement is made, as the compensation payer is responsible for paying these costs.

Where a reimbursement arrangement has been made, the injured person is responsible for paying to the agency the total of these care cost subsidies if:

• they received nursing home care, residential care or home care as a result of the injury/illness, and
• the care costs were reimbursed to the injured person by the compensation payer

Note: a refund is made only if the agency gets more than the recovery amount identified by the NOC.

If a valid Notice of past benefits (NOPB) exists when the reimbursement arrangement is made, this becomes the NOC.

If there is no valid NOC when the reimbursement arrangement is made, a Notice to claimant (NTC) is issued to the injured person upon receipt of documentation.

A NOC must be:

• issued within 3 months of receiving a valid NORA, or
• if an extension of time has been granted for the injured person to return the Statement by claimant (SBC):
• within 60 days of receiving a complete and valid SBC, or
• within 60 days of the due date of the SBC, where it was not returned, whichever is earlier

The NOC is payable within 28 days.

Section 25(4)

If the agency fails to issue a NOC within the timeframe the claim will qualify under S25(4) of the HOSC Act and the right to recover any amounts owing is waived. The agency will issue a Medicare Compensation Recovery letter.

Claims initially assessed as being not notifiable because of being received within 6 months of the arrangement being made can later become notifiable. This can occur if there are subsequent periods of denied liability that are successfully appealed.

A reimbursement arrangement made because of a successful appeal decision, is notifiable if the appeal decision that reinstates liability is:

• 6 months or more, and
• after the date the claim for compensation was made

Costs are now recoverable for periods of previously disputed liability, which are now ruled as accepted periods of liability on an appeal decision.