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CMS Rings in the New Year with an Updated WCMSA Reference Guide

The Centers for Medicare and Medicaid Services (CMS) wished us all a Happy New Year by releasing the latest version of the Workers’ Compensation Medicare Set Aside (WCMSA) Reference Guide on January 4, 2019. The noted updates are as follows:

·     To eliminate issues around Development Letter and Alert templates auto populating with individual Regional Office (RO) reviewer names and direct phone numbers, these will now display the generic “Workers’ Compensation Review Contractor (WCRC)” and the WCRC customer service number “(833) 295-3773” (Appendix 5). 

·     Per CMS’ request, certain references to memoranda on cms.gov have been removed. 

·     The CDC Life Table has been updated for 2015 (Section 10.3). 

·     Updates have been provided for spinal cord stimulators and Lyrica (Sections 9.4.5 and 9.4.6.2) 

While the above bullet points are specifically highlighted as updates, it is worth mentioning that there are several instances within the WCMSA Reference Guide where CMS highlights the fact that the submission of a Medicare Set-Aside (MSA) to CMS for approval is a voluntary process. However, the WCMSA Reference Guide goes on to indicate that receiving CMS approval of an MSA is “the only process that offers both Medicare beneficiaries and Workers’ Compensation entities finality, with respect to obligations for medical care required after settlement, award, or other payment occurs.”  While, the workers’ compensation settlement community continues to explore alternatives to CMS approval including Evidence Based Medicine (EBM) MSAs, and other non-submission programs, the goal of these approaches should always be to avoid shifting the burden of paying for post-settlement treatment to Medicare.  

To view the updated WCMSA Reference Guide in its entirety, please click here.