Updates to Workers’ Compensation Medicare Set-Aside Reference Guide
On May 13, 2023, CMS released an updated version of the Workers’ Compensation Medicare Set-Aside (MSA) Reference Guide. Most noteworthy is the removal of the six-year time limit for pursuing an Amended Review of a prior MSA approval. While Amended Review remains a one-time option to seek reductions in approved but unfunded MSAs, this change affords an opportunity to revisit open medical claims – older than six years – where an MSA was approved but the current medical status reflects a significant decrease in future care.
The updated Guide next addressed allocation of spinal cord and peripheral nerve stimulators and intrathecal pain pumps, clarifying the timing and frequency for initial placement and replacements. The revisions distinguish between claims where these items have already been implanted and where recommended but not yet done. Differences between rechargeable and non-rechargeable units continue with CMS explicitly defaulting to non-rechargeable pricing and allocation frequency where a future recommendation does not specify. Examples with detailed calculations for different scenarios are provided and helpful given recent discrepancies in MSA approvals. In addition, the new CDC Life Table was referenced and will apply to life expectancies for all future MSA approvals.
The Guide also documented certain administrative changes in the MSA approval process. Instead of CMS Regional Offices issuing initial MSA determinations, the approvals will come directly from the Workers’ Compensation Review Contractor (WCRC). The WCRC will handle customer service duties too. Interestingly, the MSP industry is awaiting an announcement regarding whether the current WCRC – Capitol Bridge since 2018 – will retain the MSA contract or whether it will be awarded to another bidder.
The NBKL Medicare Secondary Payer Compliance team is monitoring the WCRC contract award along with other MSP industry news. Our attorneys are always pleased to answer questions and address Medicare compliance issues.