The Centers for Medicare and Medicaid Services (CMS) has released the latest edition of its Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (the Toolkit) (Version 1.3; October 10, 2019). This CMS resource provides guidance for individuals who are self-administering a Workers Compensation Medicare Set-Aside (WCMSA).
The following provides a general overview of the major change made in the new Toolkit (Version 1.3):
CMS updates its toolkit to include electronic submission of annual attestation forms
As part of CMS’ WCMSA process, regardless of how the WCMSA account is administered (i.e. self-administration or professional administration) 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. Up until now, CMS has required the attestations to be submitted via mail.
Recently, however, CMS announced that it will now allow the WCMSA administrator to submit annual attestations electronically via the Workers Compensation Set-Aside Portal (WCMSAP). Click here for the author’s recent article on this update, and for information on CMS’ upcoming webinar on October 30 where CMS will address how to use the new WCMSAP functions.
In keeping in line with the updates made in the WCMSAP User Guide, Section 8 of the Toolkit has now been updated to include instructions for self-administered WCMSA on how to access the WCMSAP and to submit the attestations electronically.
Inheritance of WCMSA Funds
In addition to updating the Toolkit to address electronic submission of attestations, the Toolkit was also updated the section addressing inheritance of WCMSA funds to mirror the language of the WCMSA Reference Guide. In so doing, CMS updated the Toolkit to reflect that providers have 12 months from the date of service to submit a bill to Medicare, so the estate has an obligation to remain open to pay those charges using the WCMSA funds. Similarly, the Toolkit also further clarifies that, if applicable, settlement language will dictate how the funds should be disbursed.
Outside of these updates, the Toolkit continues to provide helpful instructional information on several important items related to self-administration of the WCMSA account, such as setting up a WCMSA bank account, WCMSA funding, how the WCMSA can be used, what to tell healthcare providers, reviewing and paying bills, keeping records, attestations, and addressing inheritance.
CMS’ Toolkit provides helpful guidance for Self-Administration
Overall, CMS’ introduction of its Toolkit a few years back has been a welcomed resource for self-administering claimants, especially since self-administration remains the primary and traditional choice for post-settlement WCMSA administration. This form of administration provides claimants with flexibility, privacy, and control over their funds. While professional administration may be necessary in certain situations, such as where claimants suffer from mental impairment or capacity issues, self-administration remains a valid, viable, and lower cost option for the administration of WCMSAs.
With the new WCMSAP and Toolkit updates, self-administration has been made easier as claimants can now submit their annual attestations electronically, which facilitates timely and regular filings, as well as having access to previous attestations for monitoring and tracking expenditures. In making this change, CMS has sensibly made it easier for claimants to track, manage, and monitor their own case without necessarily having to deal with the oversight and costs associated with involving a third-party administrator. Overall, CMS’ updates continue to make the self-administration of the WCMSA easier for claimants and provide claimants with a user-friendly and understandable resource to help them meet their post-settlement administration requirements.
Please do not hesitate to contact us if you would like additional information or assistance with determining the ideal type of administration for your claim.
 WCMSA Reference Guide 2.9, Section 17.5.