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Monday, May 23, 2011

CMS Announces Review is Only a Recommended Process for Set-Aside Agreements

The Centers for Medicare and Medicaid Services (CMS) has just announced a clarification of its prior memos concerning the review of Workers Compensation proposed Set Aside Agreements and also indicates that submission is an elective process.

"Submission of a WCMSA proposal to CMS for review and approval is a recommended process. There are no statutory or regulatory provisions requiring that a WCMSA proposal be submitted to CMS for review. However, if an entity chooses to use the WCMSA review process, CMS requests that it comply with the established policies and procedures referenced on its Web site. Claimants, employers, carriers, and their representatives should be encouraged regularly to monitor this dedicated workers’ compensation Web site for changes in policies and procedures."

CMS indicated that, "A WCMSA should not be submitted to CMS when the resolution of the workers’ compensation claim results in the medical portion of the claim is being left open." In the memo, CMS reiterates the threshold levels and eligibility for review criteria.


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