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.

LASIE Looks to Build on Momentum Gained from Burgess Decision

Louisiana employers and workers’ compensation insurers received a bit of financial relief last summer when the Louisiana Supreme Court held that employers were free to choose which pharmacy injured workers are to use to fill their prescription medications related to their industrial injury.  The decision reached by the court in Burgess v. Sewerage and Water Board of New Orleans was a pivotal first step in reining in rising workers’ compensation costs in Louisiana.

Additionally, the Supreme Court recognized the possibility that even though medical fees may fall within the amounts established in the reimbursement schedule, they may also be declared unreasonable and not subject to compensation under certain circumstances.  This decision could very well leave the door open to future legal arguments against unreasonable medical services provided by outpatient facilities.  

On the heels of the Burgess decision, our good friends at the Louisiana Association of Self Insured Employers (LASIE) are hosting a seminar on Monday, April 16, 2018 in Baton Rouge to not only discuss the financial impacts the Burgess Decision has had on pharmacy costs in Louisiana over the past 9 months, but will also offer up valuable bits of information from attorneys in Louisiana on the practical implications this decision should have on a workers’ compensation program. For registration information on this seminar, please click here.

Arizona Lawmakers Introduce Bill Allowing for the Settlement of Future Medicals

Our good friends at workcompcentral.com recently posted an article on Arizona Senate Bill 1332, which would allow complete settlements in workers’ compensation cases, including future medicals.  Lawmakers sent Gov. Doug Ducey a bill that would allow “full and final settlements” and require employers to pay for travel to medical appointments, expand existing cancer presumptions for all safety workers and create a new presumption for heart ailments suffered by firefighters.

The settlements would have to be in writing and include a description of the worker’s medical conditions that have been identified and taken into consideration when settling the claim.  If an injured worker is not represented by an attorney, a full and final settlement would not be valid until the Industrial Commission determines that the deal is in the worker’s best interest.

This is certainly an issue we will be following closely here at Legacy Claim Solutions.  If signed into law, we stand ready to assist our clients in properly valuing, negotiating, and ultimately settling all of their outstanding high exposure workers’ compensation claims in Arizona, as we currently do across the country.