Core issue: The Centers for Medicare and Medicaid Services (CMS), a part of Health and Human Services, is implementing policy relating to the Medicare secondary payor act resulting in substantial present and future challenges for the Ohio's workers compensation system. Under the Medicare secondary payor act any primary insurance payor is supposed to assume a central responsibility for paying medical bills - not transferring responsibility for those present or future claims and related billing to Medicare. So far so good. In Ohio, our present worker's compensation system is doing an excellent job of paying the primary medical bills and for the most part we've kept Medicare's interests clearly in mind and defended the spirit and letter of the set aside regulations. I believe Ohio has been a model partner to Medicare in this process.