The Centers for Medicare and Medicaid Services (CMS) has released the latest edition of its Workers’ Compensation Medicare Set-Aside Portal User Guide (WCMSAP) (Version 5.9; October 7, 2019). CMS outlines its full list of changes on page 1-1 in the new guide. This CMS resource provides guidance related to the submission of Workers’ Compensation Medicare Set-Asides (WCMSA) proposals and administration of WCMSA accounts through the WCMSAP. As outlined below, the changes primarily focus on WCMSA administration matters and will have minimal impact on the WCMSA allocation process. This new guide replaces Version 5.8 of the WCMSAP.
The following provides a general overview of select changes made in the new WCMSAP (Version 5.9):
WCMSA Administration “Attestations” can now be submitted electronically through the WCMSAP
A major update in the new guide is that CMS now allows for WCMSA administration attestations to be submitted electronically through the WCMSAP.
By way of background, as part of CMS’ WCMSA process, the WCMSA may be administered by the claimant (“self-administration”) or by a third party WCMSA administrator (“professional administration”). Regardless of how the WCMSA account is administered, the WCMSA administrator must submit a yearly “attestation” filing. Through the attestation, the administrator attests that all the payments from the WCMSA account were made for Medicare-covered expenses and related to the work-related injury, illness, or disease.
In relation to this change, the new guide updates and outlines certain procedural items, including:
- CMS has added a new account type for Professional Administration companies and provides what actions they can and cannot take, the most notable of which is allowing the professional administrator access to the portal and giving them permission to submit WCMSA transactions through the portal.
- CMS will now require more information about who is professionally administering WCMSAs when the professional administration option is selected on submission.
- In Section 12.5.1, CMS outlines the process for submitting attestations through the portal by the identified administrator, and Section 12.5.2 allows the self or Representative account administrator to view all attestations they have previously submitted. Further, CMS will now allow the beneficiary to access attestations submitted on their claim through the portal through MyMedicare.
CMS to hold webinars regarding electronic submission of attestation forms
Through a separate notice, CMS announced it will be holding two webinars to address its new policy of allowing WCMSA attestations to be submitted through the WCMSAP as follows:
- Webinar #1: WCMSA Electronic Attestation Enhancement Webinar: Wednesday, October 30, 2019 (1:00 p.m. ET)
- Webinar #2: WCMSA Electronic Attestation Enhancement for Professional Administrators: Wednesday, November 6, 2019 (1:00 p.m. ET)
Learn more about CMS’ webinars, including how to register for these sessions here.
ISO Claims Partners will attend these events and provide a post-session summary following each webinar. In the interim, please contact the author if you have any questions.
CMS removes cap on medical records submission and other changes
In addition to the changes regarding submission of the attestation forms, the new WCMSAP also makes a couple of other changes that WCMSA submitter may find helpful.
For example, parties can now set-up alerts for Re-review Approvals, Re-review Denials, Amended Review Approvals, and Amended Review Denials. Also, CMS has removed the page cap on how many medical records can be included in a single file, but the 40MB per file size limit remains. This change seems to be calibrated to allow more pages to be submitted without having to have them broken down further.
The above provides a general update of some of the key changes made by CMS in its new WCMSAP User Guide. As noted above, for a complete review of all the changes made, see page 1-1 of the guide.
ISO Claims Partners is monitoring these new changes and will provide updates as warranted. In the meantime, contact the author if you have any questions.
 WCMSA Reference Guide 2.9, Section 17.5.
 See e.g, WCMSAP Sections 2.2, 4.1, 5.2, 7, 12.2, and 12.5.
 WCMSAP Section 11.4.
 WCMSAP Section 12.5.2.
 WCMSAP Section 13.1.
 WCMSAP Section 11.11.1.