On January 10, 2022, the Centers for Medicare and Medicaid Services added Section 4.3 - The Use of Non-CMS-Approved Products to Address Future Medical Care to the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (“Guide”).

On March 2, 2022, the Centers for Medicare and Medicaid Services (“CMS”) submitted a proposed rule on Medicare Secondary Payer and Future Medicals (CMS-6047) to the White House Office of Information and Regulatory Affairs (OIRA), which if adopted could have a game-changing impact on liability, and perhaps other types of cases throughout the country.

One of the challenging tasks for MSA allocators is persuading CMS to exclude a surgical allocation when a future surgical procedure is mentioned in the medical record.

Medicare coverage is not limited to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Advantage Plans (Part C) are also an available option for Medicare beneficiaries.

Medicare exposure can be significantly impacted by claim decisions made early in the handling of a workers’ compensation case.

After a protracted settlement negotiation involving a high six figure Workers’ Compensation Medicare Set Aside approved by CMS, the parties finally reached a settlement.