A NJ Superior Court deemed a proposed Medicare Set-Aside Agreement to be satisfactory to protect Medicare's interests and granted a Motion to Enforce a Pending Settlement. This action by the Court was taken after CMS (Centers for Medicare & Medicaid Services) declined to rule on the adequacy of the Set Aside Agreement because of limited Federal resources.
"The court has thoroughly reviewed the sworn testimony of plaintiffs' expert regarding the proposed set-aside amounts for future medical expenses relating to the
underlying accidents/incidents, which would otherwise be covered or reimbursable
by Medicare. The court finds that the proposed set-aside amount in each case
fairly takes Medicare's interests into account in that the figures are both reasonable and reliable. Therefore, the court is satisfied that Medicare's interests
have been adequately protected pursuant to the MSP. Plaintiffs shall set aside the
proposed sums in self-administered interest-bearing accounts to be used solely for
the purpose of satisfying future medical expenses related to the underlying accidents/incidents."
DUHAMELL, Plaintiff v. RENAL CARE GROUP EAST, INC., RCG Southern New Jersey, LLC, Philadelphia Suburban Development Corporation, Defendants. Catherine A. Ney, Plaintiff, et al,, --- A.3d ----, 2013 WL 2102701 (N.J.Super.A.D.) Decided Dec. 7, 2012. May 16, 2013.
Showing posts sorted by relevance for query set-aside. Sort by date Show all posts
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Saturday, May 18, 2013
Tuesday, November 22, 2011
CMS Sets Telephone Conference Call to Discuss Workers' Compensation Medicare Set-aside Portal
The Centers for Medicare & Medicaid Services (CMS) has completed its Pilot Testing of the Workers' Compensation Medicare Set-aside Portal (WCMSAP). The CMS will be conducting a Town Hall conference call on November 29, 2011 from 1:00 to 3:00 pm (EST), to introduce this initiative to submitters of proposed Workers' Compensation Medicare Set-Aside Arrangement (WCMSAs) amounts, and to answer questions regarding the WCMSAP. After the Town Hall conference call, CMS will post the links of the WCMSAP application, and the WCMSAP Computer Base Training (CBT) Modules, on the Workers' Compensation Medicare Set-aside Portal (WCMSAP) section page "Related Links Outside CMS."
Please Note: The call in information for the WCMSAP Town Hall teleconference is:
Call in time: 1pm to 3pm
Call In Line: 1-(800) 603-1774
*Conference ID: 29840615
Call in time: 1pm to 3pm
Call In Line: 1-(800) 603-1774
*Conference ID: 29840615
*Participants must use the Conference ID number to be allowed into the call.
Thursday, December 8, 2011
The Workers' Compensation Medicare Set-aside Portal (WCMSAP)
The Workers' Compensation Medicare Set-aside Portal (WCMSAP) application has gone "live" and is now available for users. Prior to attempting to register, you should read the New Registration section of the User guide. The URL for the WCMSAP may be found under the "Related Links Outside CMS," on the WCMSAP section page. The WCMSAP User Guide may be found in the "Reference Material" section of the WCMSAP application.
Instructions on how to register for the Computer Based Training (CBTs) may be found in the "Workers' Compensation Medicare Set-aside Portal (WCMSAP) Computer Based Training (CBT) document under the "Downloads Links" on the WCMSAP section page (click the "How to Register for WCMSAP Computer Based Training (CBT) Modules hyperlink.") These courses are designed to assist submitters of Workers' Compensation Medicare Set-Aside Arrangements (WCMSAs) with the registration and use of the WCMSAP.
This site provides an interface for entry of Workers' Compensation Medicare Set-Aside Arrangements (WCMSA) proposals. Attorneys, Medicare beneficiaries, claimants, insurance carriers and WCMSA vendors may use this site to enter the case information directly. The site also provides attorneys, Medicare beneficiaries, claimants, insurance carriers, and WCMSA vendors with the ability to track their submitted cases and the statuses without inquiry to the Coordination of Benefits Contractor (COBC) or the Centers for Medicare & Medicaid Services (CMS).
Monday, August 8, 2011
Workers' Compensation Medicare Set-Aside Web Portal (WCMSAP) Webinar
Please read below an invitation to Submitters to attend a CMS Workers' Compensation Medicare Set-Aside Web Portal (WCMSAP) Webinar.
WCMSAP Submitters Webinar - August 10, 2011
Event Description: This Webinar will review the Workers' Compensation Medicare Set-Aside Portal (WCMSAP), a new web-based application that allows for the electronic submission and tracking of WCMSA proposals submitted to CMS for review. This Webinar will also review the current WCMSA proposal submission process, the new submission process on the WCMSAP and the WCMSAP screens that will be used to enter and submit a proposal.
Enrollment Information: To receive your Webinar access information simply send an email to Techi@nhassociates.net and include the following information. To ensure that you receive webinar access information, future notifications and announcements regarding the Webinar, please add this e-mail address (Techi@nhassociates.net) to your "Safe Sender" list in your e-mail client.
Note: Due to limited seating we will need to hold attendance to an 85 user maximum. So please reserve
your seat as soon as possible, we apologize for any inconvenience.
Information Required for WCMSAP Webinar Registration:
Name (first and last):
Email Address:
Company Name:
Tel. Number:
Receipt of invitation which reserves space in Outlook Calendar (i.e. an iCal) (Yes/No):
Thursday, September 10, 2009
CMS Lists How to Avoid 10 Top WCMSA Errors
The Centers for Medicare and Medicaid Services has now posted the 10 top errors on Workers' Compensation Set Aside Agreement submissions and how to avoid them:
1. No medical records for the last two years of treatment
2. Claims payment history missing or undated
3. Response to development requests incomplete
4. Calculation method stated as fee schedule when state does not have a fee schedule
5. Calculation method not stated for the medical set-aside
6. Total settlement amount missing or unclear
7. No rated age statement from submitter confirming that all rated ages obtained on the claimant have been included
8. Payout amount not used in annuity situations
9. Proposed medical set-aside amount is missing, unclear, or inconsistent with other information
10. Proposed prescription drug set-aside amount is missing, unclear, or inconsistent with other information
Tuesday, May 24, 2011
Court Permits Deduction of Procurement Costs From Medicare Set-Aside in Liability Claim
Following the guidelines of the CMS Management Memo entitled "Medicare Secondary Payer - Workers Compensation (WC) Information" dated May 7, 2004, and the interpretation of 42 CFR 411.37, a NJ Court granted an attorney the deduction of procurement costs from a Medicare Set-Aside Trust.
"This court's decision to apply 42 C.F.R. § 411.37 to funds obtained in a civil action and placed in a Medicare set aside is also in line with general principles of equity. Where a plaintiff is, or will within a short time become, a Medicare recipient, the plaintiff's attorney also works on behalf of Medicare to secure funds to pay future medical expenses Medicare would otherwise pay. To allow Medicare to avoid paying an equitable share of the procurement fees for a judgment or settlement amount, forcing the plaintiff to cover all the fees, would be unfair to plaintiffs. In some situations, a plaintiff may end up getting nothing after creating the set aside and paying attorneys' fees or may even have to pay money out of pocket to his attorney after a lengthy trial. Such a result would not only be inequitable, it would deter persons on Medicare who are injured by the tortious acts of others from bringing claims."
Hinsinger v. Showboat Atlantic City, L-3460-07, 2011 WL 1885980 (NJ Super Law Division 2011), decided May 19, 2011.
"This court's decision to apply 42 C.F.R. § 411.37 to funds obtained in a civil action and placed in a Medicare set aside is also in line with general principles of equity. Where a plaintiff is, or will within a short time become, a Medicare recipient, the plaintiff's attorney also works on behalf of Medicare to secure funds to pay future medical expenses Medicare would otherwise pay. To allow Medicare to avoid paying an equitable share of the procurement fees for a judgment or settlement amount, forcing the plaintiff to cover all the fees, would be unfair to plaintiffs. In some situations, a plaintiff may end up getting nothing after creating the set aside and paying attorneys' fees or may even have to pay money out of pocket to his attorney after a lengthy trial. Such a result would not only be inequitable, it would deter persons on Medicare who are injured by the tortious acts of others from bringing claims."
Hinsinger v. Showboat Atlantic City, L-3460-07, 2011 WL 1885980 (NJ Super Law Division 2011), decided May 19, 2011.
Friday, July 8, 2011
Workers’ Compensation Medicare Set-Aside Portal (WCMSAP)
The Centers for Medicare & Medicaid Services (CMS) is currently Pilot Testing the Workers' Compensation Medicare Set-aside Portal (WCMSAP), a web-based application. This new initiative will allow submitters of Workers' Compensation Medicare Set-Aside Arrangements (WCMSAs) to directly enter case information, upload documentation, and receive case status information through the use of a secure Web portal.
This secure Web portal will greatly improve the efficiency of the submission process for WCMSAs, including receipt of the proposal by its Workers' Compensation Review Contractor (WCRC). The WCMSAP, a web-based application, will allow attorneys, beneficiaries, claimants, insurance carriers, representative payees, and WCMSA vendors to:
• Create a work-in-progress case
• Submit WCMSA cases
• Perform case lookups
• Append documentation to a case
• Submit WCMSA cases
• Perform case lookups
• Append documentation to a case
Friday, March 29, 2013
CMS Publishes Brand New Reference Guide for Medicare Set-Aside Arrangements
A new Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available to be downloaded on the CMS (Centers for Medicare & Medicad Services) website.This reference guide was created to consolidate information currently found within the Workers’ Compensation Agency Services webpages and CMS Regional Office Program Memorandums, while providing WCMSA information to attorneys, Medicare beneficiaries, claimants, insurance carriers, representative payees, and
CMS cautions that parties should continue to visit their website for future updates to the reference guide, including additional details regarding the Workers’ Compensation Review Contractor’s review process.
Read more about WCMSA and workers' Compensation:
Feb 21, 2013
Effective immediately, if a WCMSA proposal amount was originally submitted via the web-portal, a re-evaluation of an approved WCMSA amount can be requested through the WCMSA web portal, if the claimant or submitter ...
Monday, June 17, 2013
Proposed Medicare Payment Reductions Will Impact Workers' Compensation Costs
A government Medicare advisory panel reported on Friday that sweeping changes should be implemented to reduce increasing medical costs, including higher costs associated with hospital purchased physician practices. The impact of those proposed adjustments will significantly impact the national workers' compensation systems because of both direct and indirect links between the two programs, including medical fee schedules, and Medicare Secondary Payment reimbursements.
The Medicare Payment Advisory Commission (MedPAC) releases its June 2013 Report to the Congress:
Medicare and the Health Care Delivery System.
According to Commission Chair Glenn Hackbarth, “This report can inform a dialogue about future
directions for the Medicare program, as well as about technical refinements to existing Medicare
payment policy. Whether broad or narrow, the Commission’s work aims to balance the interests of
Medicare beneficiaries, health care providers, and tax payers.”
Redesigning the Medicare benefit. In the report, the Commission continues its discussion of
possible ways to redesign the Medicare benefit by focusing on the concept we refer to as competitively
determined plan contributions (CPC). Under CPC, Medicare beneficiaries could receive care through
either a private plan or traditional fee-for-service (FFS), but the premium paid by the beneficiary might
vary depending on the coverage option they choose. How much the federal government pays for a
beneficiary’s care would be determined through a competitive process comparing the costs of available
options for coverage. The report identifies key issues to be addressed if the Congress wishes to pursue a
policy option like CPC. These include how benefits could be standardized for comparability, how to
calculate the Medicare contribution, the role FFS, and the structure of subsidies for low-income
beneficiaries.
Reducing Medicare payment differences across sites of care. Medicare’s payment rates often
vary for similar services provided to similar patients, simply because they are provided in different sites of
care. For example, Medicare pays 141 percent more for one type of echocardiogram when done in a
hospital outpatient department than when it is done in a freestanding physician’s office. If Medicare pays a
higher rate for a service in one setting over another, program spending increases and beneficiaries pay
more in cost sharing without a corresponding increase in quality of care.
The Commission previously recommended reducing the rate Medicare pays for basic office visits from the
payment rate in the outpatient setting to the physician office rate. Using similar criteria, this report identifies
additional services that may be eligible for equalizing or narrowing payment differences across settings.
Bundling post-acute care services. Each year, about one-quarter of Medicare beneficiaries receive
care following a hospitalization from a post-acute care provider, such as a skilled nursing facility, home
health agency, or inpatient rehabilitation facility. However, nationwide the use of these services varies
widely, for reasons not explained by differences in beneficiaries’ health status. Under traditional
Medicare, the program pays widely varying rates for different settings and—characteristic of FFS—pays
based on the volume of care provided, without regard to quality or resource use.
Medicare has begun to explore the possibility of bundling services as a way to encourage providers to
coordinate and furnish needed care more efficiently. In this report, the Commission explores the
implications for quality and program spending for different design features of the bundles, such as the
services included, the length of time covered by the bundle, and the method of payment.
Reducing hospital readmissions. In 2008, the Commission recommended a hospital readmissions
reduction program to improve patient experience and reduce Medicare spending. In 2012, Medicare
began such a program, penalizing hospitals that have high rates of Medicare beneficiaries being
readmitted to the hospital within 30 days of discharge. The readmission penalty has given hospitals a
strong incentive to improve care coordination across providers, and for that reason Medicare should
continue to implement the policy. In this report, the Commission suggests further refinements to
improve incentives for hospitals and generate program savings through reduced readmissions rather than
higher penalties.
Payments for hospice services. The Medicare hospice benefit provides beneficiaries an important
option for end-of-life care. At the same time, the Commission has identified several problems in the way
Medicare pays for hospices that may lead to inappropriate use of the benefit. The report presents
information on the prevalence of long-stay patients and the use of hospice services among nursing home
patients—both of which may inform policy development in the hospice payment system in the future. It
also presents further evidence to support the Commission’s March 2009 recommendations to revise the
hospice payment system.
Improving care for dual-eligible beneficiaries. Beneficiaries eligible for both Medicare and
Medicaid—many of whom have complex medical and social needs—often have trouble accessing
services and receive little care coordination, resulting in poorer health outcomes and higher spending
relative to other beneficiaries. Programs that coordinate dual-eligible beneficiaries’ Medicare and
Medicaid benefits have the potential to improve care for this population. In the report, the Commission
notes that federally qualified health centers and community health centers may be uniquely positioned to
coordinate care for dual-eligible beneficiaries because they provide primary care, behavioral health
services, and care management services, often at the same clinic site.
Mandated reports. The report includes three chapters that fulfill Congressional mandates: one on
Medicare ambulance add-on payments, a second on geographic adjustment of fee schedule payments for
the work effort of physicians and other health professionals, and a third on Medicare payment for
outpatient therapy services. In each case, the Commission considers the existing policies—which are not
permanent statutory provisions—and examines the effect of their continuation or termination on
program spending, beneficiaries’ access to care, and the quality of care beneficiaries receive, as well as
their potential to advance payment reform.
The three congressionally mandated reports are described in further detail in separate fact sheets, posted
on MedPAC’s website. The full report can be downloaded from MedPAC’s website:
http://medpac.gov/documents/Jun13_EntireReport.pdf
Read more about Medicare and Workers' Compensation
The Medicare Payment Advisory Commission (MedPAC) releases its June 2013 Report to the Congress:
Medicare and the Health Care Delivery System.
According to Commission Chair Glenn Hackbarth, “This report can inform a dialogue about future
directions for the Medicare program, as well as about technical refinements to existing Medicare
payment policy. Whether broad or narrow, the Commission’s work aims to balance the interests of
Medicare beneficiaries, health care providers, and tax payers.”
Redesigning the Medicare benefit. In the report, the Commission continues its discussion of
possible ways to redesign the Medicare benefit by focusing on the concept we refer to as competitively
determined plan contributions (CPC). Under CPC, Medicare beneficiaries could receive care through
either a private plan or traditional fee-for-service (FFS), but the premium paid by the beneficiary might
vary depending on the coverage option they choose. How much the federal government pays for a
beneficiary’s care would be determined through a competitive process comparing the costs of available
options for coverage. The report identifies key issues to be addressed if the Congress wishes to pursue a
policy option like CPC. These include how benefits could be standardized for comparability, how to
calculate the Medicare contribution, the role FFS, and the structure of subsidies for low-income
beneficiaries.
Reducing Medicare payment differences across sites of care. Medicare’s payment rates often
vary for similar services provided to similar patients, simply because they are provided in different sites of
care. For example, Medicare pays 141 percent more for one type of echocardiogram when done in a
hospital outpatient department than when it is done in a freestanding physician’s office. If Medicare pays a
higher rate for a service in one setting over another, program spending increases and beneficiaries pay
more in cost sharing without a corresponding increase in quality of care.
The Commission previously recommended reducing the rate Medicare pays for basic office visits from the
payment rate in the outpatient setting to the physician office rate. Using similar criteria, this report identifies
additional services that may be eligible for equalizing or narrowing payment differences across settings.
Bundling post-acute care services. Each year, about one-quarter of Medicare beneficiaries receive
care following a hospitalization from a post-acute care provider, such as a skilled nursing facility, home
health agency, or inpatient rehabilitation facility. However, nationwide the use of these services varies
widely, for reasons not explained by differences in beneficiaries’ health status. Under traditional
Medicare, the program pays widely varying rates for different settings and—characteristic of FFS—pays
based on the volume of care provided, without regard to quality or resource use.
Medicare has begun to explore the possibility of bundling services as a way to encourage providers to
coordinate and furnish needed care more efficiently. In this report, the Commission explores the
implications for quality and program spending for different design features of the bundles, such as the
services included, the length of time covered by the bundle, and the method of payment.
Reducing hospital readmissions. In 2008, the Commission recommended a hospital readmissions
reduction program to improve patient experience and reduce Medicare spending. In 2012, Medicare
began such a program, penalizing hospitals that have high rates of Medicare beneficiaries being
readmitted to the hospital within 30 days of discharge. The readmission penalty has given hospitals a
strong incentive to improve care coordination across providers, and for that reason Medicare should
continue to implement the policy. In this report, the Commission suggests further refinements to
improve incentives for hospitals and generate program savings through reduced readmissions rather than
higher penalties.
Payments for hospice services. The Medicare hospice benefit provides beneficiaries an important
option for end-of-life care. At the same time, the Commission has identified several problems in the way
Medicare pays for hospices that may lead to inappropriate use of the benefit. The report presents
information on the prevalence of long-stay patients and the use of hospice services among nursing home
patients—both of which may inform policy development in the hospice payment system in the future. It
also presents further evidence to support the Commission’s March 2009 recommendations to revise the
hospice payment system.
Improving care for dual-eligible beneficiaries. Beneficiaries eligible for both Medicare and
Medicaid—many of whom have complex medical and social needs—often have trouble accessing
services and receive little care coordination, resulting in poorer health outcomes and higher spending
relative to other beneficiaries. Programs that coordinate dual-eligible beneficiaries’ Medicare and
Medicaid benefits have the potential to improve care for this population. In the report, the Commission
notes that federally qualified health centers and community health centers may be uniquely positioned to
coordinate care for dual-eligible beneficiaries because they provide primary care, behavioral health
services, and care management services, often at the same clinic site.
Mandated reports. The report includes three chapters that fulfill Congressional mandates: one on
Medicare ambulance add-on payments, a second on geographic adjustment of fee schedule payments for
the work effort of physicians and other health professionals, and a third on Medicare payment for
outpatient therapy services. In each case, the Commission considers the existing policies—which are not
permanent statutory provisions—and examines the effect of their continuation or termination on
program spending, beneficiaries’ access to care, and the quality of care beneficiaries receive, as well as
their potential to advance payment reform.
The three congressionally mandated reports are described in further detail in separate fact sheets, posted
on MedPAC’s website. The full report can be downloaded from MedPAC’s website:
http://medpac.gov/documents/Jun13_EntireReport.pdf
Read more about Medicare and Workers' Compensation
May 18, 2013
A NJ Superior Court deemed a proposed Medicare Set-Aside Agreement to be satisfactory to protect Medicare's interests and granted a Motion to Enforce a Pending Settlement. This action by the Court was taken after CMS ...
Mar 29, 2013
A new Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available to be downloaded on the CMS (Centers for Medicare & Medicad Services) website.
Jan 11, 2013
"The legislation changes the way Medicare collects money from people whose negligence caused a patient to incur medical bills. Murphy said the new law will streamline an outdated process, making it easier to close cases ...
Monday, August 17, 2009
AAJ Comments that Medicare Set-Asides Only Recommend
The American Association for Justice issued a statementt that Medicare Set Aside Agreements were only "recommended" by CMS in workers' compensation claims. In interpreting the reporting requirements of Section 111 Medicare, Medicaid & SCHIP Act of 2007 (MMSEA), Public Law No. 110-173, AAJ declared that there no shift of responsibility that would mandate Set Aside Agreements in liability claims.
For more information on Set Aside Agreements visit the Workers' Compensation Blog.
Thursday, June 27, 2013
CMS Consolidates Web Portals for Coordination of Benefits & Recovery
The Coordination of Benefits and Medicare Secondary Payer Recovery sections on the Medicare tab of the CMS.Gov Web Site have been combined into a single, comprehensive section titled, Coordination of Benefits & Recovery.
The Web Site redesign consolidates information into groupings by audience and topic. To
CMS provides the ability for you to be automatically notified when changes are made to a section under Coordination of Benefits & Recovery.
To sign-up for these notifications, select one of the Web Site links (e.g. Insurer Services) and click on the Sign-up Notification link found in the Related Links area near the bottom of the page. You will be asked to supply your email address and then be taken to a selection page. Scroll to the Coordination of Benefits & Recovery heading and select the section or sections for which you wish to receive notifications. When new information is added to a section you have selected, you will be notified via email.
For those users that regularly visit the Web Site, short-cut links have been created for ease of access:
Coordination of Benefits & Recovery Overview: http://go.cms.gov/cobro
Attorney Services: http://go.cms.gov/attorney
Beneficiary Services: http://go.cms.gov/
COBA Trading Partners: http://go.cms.gov/cobatp
Employer Services: http://go.cms.gov/employer
Insurer Services: http://go.cms.gov/insurer
Prescription Drug Assistance Programs: http://go.cms.gov/
Provider Services: http://go.cms.gov/
Mandatory Insurer Reporting For Group Health Plans: http://go.cms.gov/mirghp
Mandatory Insurer Reporting For Non Group Health Plan: http://go.cms.gov/mirnghp
Tuesday, February 9, 2010
CMS Set-Aside Rules Raise Concern of Civil Trial Bar
At a recent continuing legal education program in Wisconsin members of the plaintiff and defense civil trial bar raised their concerns over the Rules governing CMS set-aside arrangements. While both sides recognized the need to reimburse Medicare, the methods being utilized by CMS to obtain reimbursement of future medical expenses caused deep concern by the lawyers.
Click here to read more about CMS Set-aside arrangements.
Click here to read more about CMS Set-aside arrangements.
Thursday, February 21, 2013
CMS Announces New WCMSA Re-Evaluation Procedure
February 12, 2013
Effective immediately, if a WCMSA proposal amount was originally submitted via the web-portal, a re-evaluation of an approved WCMSA amount can be requested through the WCMSA web portal, if the claimant or submitter believes that a CMS determination:
• contains obvious mistakes, such as mathematical errors or a failure to recognize that medical records already submitted show a surgery CMS priced has already occurred, or
• misinterpreted evidence previously submitted, a re-evaluation maybe requested.
Please refer to Question # 12 of the July 11, 2005, procedure memorandum located in the “downloads” section of this page for detailed information regarding when a re-evaluation request maybe submitted. The CMS Regional Offices will continue to review the requests submitted through the portal.
Posted on CMS Workers Compensation Agency Services
Read more about WCMSA and workers' compensation
Jan 03, 2012
Address for submitting annual accounting documentation to CMS' Medicare Secondary Payer Recovery Contractor (MSPRC). Please send your completed annual Workers' Compensation Medicare Set-aside Arrangement ...
Dec 19, 2008
The Centers for Medicare and Medicaid Services (CMS) has now published a copy of its Operating Rules regarding the evaluation of set-aside proposals. CMS cited that distribution of this material may reduce review time by ...
Jun 06, 2008
CDC in Reviewing WCMSA Limits Review to One Life Expectancy Table. Effective July 1, 2008 the Centers for Medicare and Medicad (CMS) will exclusively use the Centers for Disease Control (CDC) Table 1 (Life Table for ...
Sep 10, 2009
CMS Lists How to Avoid 10 Top WCMSA Errors. The Centers for Medicare and Medicaid Services has now posted the 10 top errors on Workers' Compensation Set Aside Agreement submissions and how to avoid them: 1.
Monday, April 14, 2014
CMS Posts WCMSA Self-Administration Guidance
A new WCMSA Self-Administration page has been added to the Workers Compensation Medicare Set-Aside Arrangement section of CMS.gov. The new page contains information for individuals who choose to self-administer their WCMSA accounts. Materials available on the new page include:
- New Self-Administration Toolkit for WCMSAs
- Account Expenditure for Lump Sum Account (Attestation Letter)
- Account Expenditure for Structured Annuity (Attestation Letter)
- Transaction Record Sample
- WCMSA Reference Guide
The following link may be used to access the page http://go.cms.gov/WCMSASelfAdm
Related Articles:
Nov 07, 2013
An updated Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide is now available in the Downloads section found at the bottom of this page. This version documents the current WCMSA ...
Feb 21, 2013
Effective immediately, if a WCMSA proposal amount was originally submitted via the web-portal, a re-evaluation of an approved WCMSA amount can be requested through the WCMSA web portal, if the claimant or submitter ...
Apr 02, 2013
The CMS will be hosting a WCMSA teleconference on April 11, 2013. This event will provide stakeholders an opportunity to learn more about the Workers' Compensation Review Contractor (WCRC), and discuss procedural ...
Jan 03, 2012
Please send your completed annual Workers' Compensation Medicare Set-aside Arrangement (WCMSA) Account Expenditure accounting documentation to the CMS lead Medicare Contractor at the address below: MSPRC ...
Monday, April 8, 2013
CMS Defines Further Defines Policy Implementation on Part D Coverage of Benzodiazepines and Barbiturates
CMS issued the following statement today concerning its policy implementation on Part D Coverage of Benzodiazepines and Barbiturates
"On October 2, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Sponsors concerning the transition to Part D Coverage of Benzodiazepines and Barbiturates beginning in 2013.
"Effective June 1, 2013, all Workers’ Compensation Medicare Set-Aside (WCMSA) proposals submitted to CMS for a review of the adequacy of the proposal amount are to include the pricing of benzodiazepines and barbiturates, where appropriate.
"Please note that WCMSA cases submitted to CMS before June 1, 2013, closed due to missing, incomplete and/or inadequate supporting documentation (or any other reason), and subsequently re-opened after June 1, 2013, will also be subject to a review that includes the pricing of benzodiazepines and barbiturates.
Wednesday, June 25, 2014
N.F.L. Makes Open-Ended Commitment to Retirees in Concussion Suit
Barring professional athletes from claiming workers' compensation benefits did not stop the mass filing of civil action claims for intentional harm against the NFL Today's post is shatred from the nytimes.com
The N.F.L. has made an open-ended commitment to pay cash awards to retirees who suffer from dementia and other diseases linked to repeated head hits, according to documents filed in the United States District Court for the Eastern District of Pennsylvania on Wednesday.
The guarantee is part of a revised settlement in the contentious lawsuit filed by about 5,000 retired players who accused the league of hiding from them the dangers of concussions.
In August, the league agreed to pay $765 million to settle the suit with the retired players, with $680 million of that amount set aside for cash awards. But Judge Anita B. Brody rejected the proposal in January because she said she doubted whether there would be enough money to cover all the claims over the 65-year life of the settlement.
Lawyers for the league and the plaintiffs spent the past six months revising the settlement. If the judge approves the new version in the coming weeks, it will be sent to all 18,000 retired players and their beneficiaries, who can then approve the settlement, object or opt out of it. The results of that vote are unlikely to be known for at least several months, and no players will be paid until all appeals are exhausted.
The league’s new promise to compensate all qualified claims could convince retirees who said they would opt out of the original settlement because they felt the league could have set aside more money for players with serious neurological disorders.
“Today’s...
[Click here to see the rest of this post]
The N.F.L. has made an open-ended commitment to pay cash awards to retirees who suffer from dementia and other diseases linked to repeated head hits, according to documents filed in the United States District Court for the Eastern District of Pennsylvania on Wednesday.
The guarantee is part of a revised settlement in the contentious lawsuit filed by about 5,000 retired players who accused the league of hiding from them the dangers of concussions.
In August, the league agreed to pay $765 million to settle the suit with the retired players, with $680 million of that amount set aside for cash awards. But Judge Anita B. Brody rejected the proposal in January because she said she doubted whether there would be enough money to cover all the claims over the 65-year life of the settlement.
Lawyers for the league and the plaintiffs spent the past six months revising the settlement. If the judge approves the new version in the coming weeks, it will be sent to all 18,000 retired players and their beneficiaries, who can then approve the settlement, object or opt out of it. The results of that vote are unlikely to be known for at least several months, and no players will be paid until all appeals are exhausted.
The league’s new promise to compensate all qualified claims could convince retirees who said they would opt out of the original settlement because they felt the league could have set aside more money for players with serious neurological disorders.
“Today’s...
[Click here to see the rest of this post]
Related articles
- Concern Raised Over Opt-Out Terms of NFL Concussion Settlement (workers-compensation.blogspot.com)
- With N.F.L. Concussion Deal, Two Tiers of Payouts (workers-compensation.blogspot.com)
- Judge Refuses to Sign Off on NFL Settlement (workers-compensation.blogspot.com)
- NFL concussion payout formula would provide up to $5 million per retired player (workers-compensation.blogspot.com)
- California limits workers' comp sports injury claims (workers-compensation.blogspot.com)
- Uncertainty Over Whether N.F.L. Settlement's Money Will Last (workers-compensation.blogspot.com)
Monday, August 12, 2013
CMS Releases Revised List of Workers Compensation Set-Aside Contacts
The Centers for Medicare and Medicaid Services has released a revised list of contacts for Workers' Compensation Set-Aside Contacts. The contacts have been centralized in 6 areas of the US.
Click here to download the PDF version of the revised list of contacts.
Click here to download the PDF version of the revised list of contacts.
Thursday, November 7, 2013
New WCMSA Reference Guide is Now Available
An updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide is now available in the Downloads section found at the bottom of this page. This version documents the current WCMSA review process and provides more detailed information on the actions performed by the Workers’ Compensation Recovery Contractor (WCRC).
CMS is currently working on additional enhancements to the WCMSA process. Stakeholders will be notified of these proposed changes prior to implementation. Please continue to monitor the WCMSA website for updates.
The following sections of the Guide have been enhanced or added:
- 9.4.1.1 – Most Frequent Reasons for Development Requests: The five most common omissions as provided by the WCRC.
- 9.4.2 – WCRC Team Background and Resources Used: The expertise of the WCRC reviewers as well as the resources used when reviewing a WCMSA.
- 9.4.3 – WCRC Review Considerations: Examples of the questions and factors that guide the WCRC’s review of WCMSA proposals. The overarching guidelines used in treatment allocations and pricing is also provided.
- 9.4.4 – Medical Review: A diagram and steps the WCRC follows in its medical review process with a general explanation of documentation requirements.
- 9.4.5 – Medical Review Guidelines: Considerations and examples in specific medical cases and topics.
- 9.4.6.1 – Prescription Drug Review: Details the process the WCRC follows in reviewing prescription medication allocations and the resources that may be used.
- 9.4.6.2 – Pharmacy Guidelines and Conditions: Discusses specific drug usage and pricing considerations.
- 10.1.8 – Pay history added to list of information needed for WCMSA submission.
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