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Workers' Compensation Medicare Set-Aside (WCMSA)

Jp Valery Lvfoii3sjq8 Unsplash

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.

John Schnobrich Flpc9 Vocj4 Unsplash

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).

Abby Anaday Z3fxpuxa15k Unsplash

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.

Pawel Czerwinski 2y8ol Obs1i Unsplash

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

Medical Treatment

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.

Mika Baumeister Wpnoqo2plfa Unsplash 1

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.

Wcmsaguide2 9

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.

Beatriz Perez Moya Xn4t2pvuugk Unsplash

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).

Dan Dimmock Snwnjxm8ety Unsplash

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.

Joshua Coleman Vf7v9mwonlk Unsplash

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.

Helloquence Oqmzwnd3thu Unsplash

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.

Files

5/22/2018 - 5 min read

Arizona tweaks its "full & final" workers' comp settlement law - New law provides opportunities to settle workers' comp claims

Arizona Senate Bill 1100 provides unprecedented opportunities to settle workers' compensation claims in the state.

Michael Longmire Lhltmgdohc8 Unsplash

5/9/2018 - 6 min read

Five steps to reduce your WCMSA costs

It is no secret that high Workers’ Compensation Medicare Set Aside (WCMSA) allocation amounts can complicate claim settlement.

Sign

4/18/2018 - 3 min read

New Kentucky workers’ compensation law limits treatment to 780 weeks for certain claims

On March 30, 2018, Kentucky House Bill (HB-2) was signed into law which makes major changes to the Kentucky workers’ compensation statute.

Michael Longmire 1bbm4i6g2zm Unsplash

4/12/2018 - 2 min read

CMS issues new regulations aimed at identifying and limiting potential opioid abuse

On April 2, 2018, C,S issued a final rule which updated regulations for Medicare Advantage Plans (MAP) and Medicare Part D programs.

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