The effects of a government shutdown on state workers' compensation systems and their integration with Social Security will vary depending on the specific circumstances of each state. However, some general trends can be expected.
Showing posts with label WCMSA. Show all posts
Showing posts with label WCMSA. Show all posts
Friday, September 29, 2023
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 ...
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.
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
Saturday, May 18, 2013
NJ Court Approves Medicare Set-Aside Agreement Lacking CMS Review
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.
"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.
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.
Tuesday, April 2, 2013
CMS Hosting a Town Hall Event for WCMSA
Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Town Hall Event
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 matters that are not case specific.
In an effort to address as many topics as possible, CMS is requesting stakeholders to submit non-case specific questions they would like to have addressed during the teleconference to the CMS MSP Central mailbox* prior to the teleconference. CMS will review and categorize the questions submitted and attempt to answer as many questions as possible during the teleconference. There may also be an opportunity for the stakeholders to ask questions after the presentation.
Date of Teleconference: April 11, 2013
Call-in time for all calls: 2:30-4:30p.m. EST
Call-in line: (800) 603-1774
Pass Code: WCRC
Questions for call: Please submit to CMS mspcentral@cms.hhs.gov*
Questions may be submitted beginning April 1, 2013 thru April 5, 2013 @ 3:30 p.m. EST.
All questions submitted for the teleconference to the email address shown above should clearly state in the subject line “WCRC April 11, 2013 Town Hall Teleconference.”
Note: Questions submitted to the mailbox after the date and time noted above will not be considered.
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 ...
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.
Tuesday, August 14, 2012
CMS Rules Out TENS Units for Low Back Pain
The Centers for Medicare and Medicaid (CMS) has issued a ruling that will impact on the payment of proceeds in Workers' Compensation Medicare Set Aside Agreements (WCMSA). CMS has ruled out the use of TENS (Transcutaneous Electrical Nerve Stimulation) units for the treatment of chronic low back pain.
"For those WC [workers' compensation]cases that were not settled prior to June 8, 2012, and where the WCMSAs proposal includes funding for TENS for CLBP [chronic low back pain] as part of the WCMSA, CMS will re-review the cases and remove pricing for TENS for CLBP. (Regional Offices shall obtain from submitters requests for a case re-review, along with a signed statement indicating a settlement had not occurred prior to June 8, 2012.)"
Case law throughout the country has been divided on whether TENS units should be authorized to cure and relieve low back pain.
Click here to read: Decision Memo for Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain (CAG-00429N)
Click here to read: Impact of the Removal of coverage of Transcutaneous Electrical Nerve
Stimulation (TENS) Units for Chronic Low Back Pain (CLBP) on Workers’ Compensation Medicare Set-Aide Arrangement (WCMSA) proposals – INFORMATION
.....
For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
Related articles
Subscribe to:
Posts (Atom)