Workers' Compensation Medicare Set-Aside (WCMSA)

11/8/2019 - 4 min read

CMS holds webinar on WCMSA Electronic Attestations for Professional Administration

On 11/6/19, CMS held a webinar on Workers’ Compensation Medicare Set-Aside (WCMSA) Electronic Attestation Enhancement for Professional Administrators.

11/1/2019 - 4 min read

CMS holds webinar on WCMSA Electronic Attestations for Self-Administered Accounts

On 10/30/19, CMS held a webinar to discuss recent enhancements to the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP).

10/31/2019 - 6 min read

CMS releases new WCMSA Reference Guide (Version 3.0)

CMS has released a revised Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (Version 3.0, October 10, 2019).

10/18/2019 - 3 min read

CMS releases WCMSA Self-Administration Toolkit 1.3

CMS has released the latest edition of its Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (Version 1.3; October 10, 2019).

10/11/2019 - 8 min read

Ninth Circuit: CIGA is not a “primary payer” under the MSP and does not have to reimburse Medicare

In a significant new case out of California, the United States Circuit Court of Appeals (Ninth Circuit)[1] in California Insurance Guarantee Association (CIGA) v. Azar, 2019 WL 5076945 (9th Cir. Oct. 10, 2019) reversed the United States District Court for the Central District Court of California [2] and ruled that CIGA is not a “primary plan” under the Medicare Secondary Payer (MSP) statute and, therefore, not liable to reimburse Medicare conditional payments made on behalf of workers’ compensation claimants.

10/10/2019 - 3 min read

CMS releases WCMSA Portal User Guide Version 5.9

On 10/7/19, CMS released the latest edition of its Workers’ Compensation Medicare Set-Aside Portal User Guide (WCMSAP) (Version 5.9).

9/17/2019 - 1 min read

CMS will use the 2016 CDC Life Table for WCMSAs starting 10/12/19

On 9/12/19, CMS announced beginning 10/12/19, it will use the new 2016 CDC Life Table to calculate adjusted life expectancies in WCMSAs.

8/1/2019 - 3 min read

WCMSA RX update – FDA approves first generics of Lyrica

On 7/22/19, the FDA announced it approved the first generics of Lyrica. This comes at a critical time as CMS has increasingly been including Lyrica in WCMSAs

5/28/2019 - 3 min read

Georgia senate bill 135 adds exceptions to the 400 week limit for future medicals – Overview and WCMSA impact

Georgia Senate Bill 135 (SB 135) was signed into law on May 7, 2019 and makes notable changes to Chapter 9 of Title 34 of the Official Code of Georgia Annotated related to workers’ compensation.

2/25/2019 - 1 min read

CMS to mask health insurance claim number and social security number on contractor correspondence starting April 2019

Starting 4/1/19, CMS’s Coordination of Benefits and Recovery Program program will mask the social security number (SSN) and SSN-portion of the health insurance claim number on all ongoing letters.

1/7/2019 - 4 min read

CMS releases new WCMSA Reference Guide (Version 2.9)

On 1/4/19, CMS released their latest version of the WCMSA reference guide Version 2.9.

12/13/2018 - 1 min read

CMS will use the 2015 CDC Life Table for WCMSAs starting 1/5/19

In an alert dated December 5, 2018, the Centers for Medicare and Medicaid Services (CMS) announced that beginning January 5, 2019, they will use the new 2015 CDC Life Table to calculate adjusted life expectancies in Workers’ Compensation Medicare Set-Asides (WCMSAs).

10/5/2018 - 2 min read

CMS releases new WCMSA Reference Guide and NGHP Section 111 User Guide

The Centers for Medicare and Medicaid Services (CMS) has updated both its Workers' Compensation Medicare Set-Aside (WCMSA) Reference Guide and its Non-Group Health Plan (NGHP) Section 111 User Guide.

8/14/2018 - 6 min read

Drug formularies continue to expand in workers’ comp systems

Balancing rising medical and pharmaceutical costs with appropriate and timely treatment for injured workers has been an ongoing struggle for workers’ compensation professionals. But recent trends indicate a positive change for the industry.

6/29/2018 - 2 min read

Workers’ Compensation Medicare Set Aside Legislation Filed, Referred to Committee

On June 18, 2018, Senators Rob Portman (R-OH) and Bill Nelson (D-FL) introduced legislation aimed at reforming the Centers for Medicare and Medicaid Services’ (CMS) Workers’ Compensation Medicare Set-Aside (WCMSA) process.