New WCRC contract bid could indicate expansion of MSAs beyond workers' compensation

By Sidney Wong September 13, 2016

On September 6, the Centers for Medicare and Medicaid Services (CMS) updated a previously released pre solicitation notice regarding a new contract for the Workers’ Compensation Review Contractor (WCRC). The WCRC reviews and approves Medicare Set-Asides (MSAs) in conjunction with workers' compensation settlements. In a prior notice, CMS announced that the new contractor should prepare for the possibility that the contract could involve the review of settlements for claims “other than” workers' compensation.

We’ve been watching for any signs that CMS may expand its regulations beyond workers' compensation since its June 8 announcement in which CMS explained that it anticipated changes to its policy regarding the treatment of post settlement medical in liability settlements. Although the CMS announcement forecasted that town hall conference calls would be forthcoming, no policy update or town hall call dates have been released.

The latest announcement explains that CMS will release a solicitation for the WCRC on or about September 22, with an anticipated proposed due date of October 24. The updated notice reiterates that the new contractor will evaluate workers' compensation Medicare Set-Asides and, “on an optional basis,” evaluate proposals from “other non-group health plans.”

What do insurers need to know right now?

This announcement has no immediate impact on claims payers. However, it does reemphasize CMS’s willingness to alter its policies regarding post settlement medical, particularly in liability cases. We continue to await any announcements on this point.

Points to consider moving forward

In the bigger picture, this is an important long-term development in Medicare Secondary Payer (MSP) compliance. With regard to workers' compensation, any change in contractors can affect the way Medicare Set-Asides are reviewed and projected. Historically, the transition to a new contractor yields changes large and small in the way MSAs are reviewed—from turnaround time, to points of emphasis in the review process, to the likelihood that the case will be approved. The transition to a new contractor takes time, and, of course, it’s also possible that the existing contractor will be awarded the contract. If a new contractor is selected, we don’t anticipate any changes until well into 2017.

The far more critical issue is that of potential liability set-asides. ISO Claims Partners is closely monitoring for any announcements in this area—particularly the promised town hall conferences and any policy changes. We’ll provide analysis, recommendations, and advocacy should any policy announcements ultimately be made.


Sidney Wong

Sidney Wong is the assistant vice president of policy at ISO Claims Partners, where he provides the highest level of client services—with a focus on meeting the needs of clients through ISO’s products and services. He is also responsible for assisting clients with effectively navigating Medicare compliance issues.