A portent of things to come? CMS releases revised WCRC contract pre-solicitation

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, News and Events on April 19, 2016
Posted by Kimberly Wiswell

CMS has revised their pre-solicitation for the WCRC contract with the following statement:

ATTENTION: RFP-CMS-2016-8A-0008 PRE-SOLICITATION notice has been updated as follows. The Centers for Medicare and Medicaid Services (CMS) has adjusted the referenced solicitation for the Workers’ Compensation Review Contractor (WCRC) due to updates that are currently being made to the Statement of Work (SOW) to include the processing of other Non-Group Health Plan (NGHP) Medicare Set-aside Arrangements.

CMS anticipates releasing a solicitation for the WCRC on or about June 27, 2016 as a full and open competitive 8(a) set-aside utilizing FAR part 15 procedures. The contract will be awarded on a Firm Fixed Price (FFP) basis and will include a 12 month base period plus four (4) one (1) year options. The anticipated proposal due date is July 27, 2016 with an anticipated award date of November 7, 2016. This solicitation is expected to be issued pending the availability funds.

Based on recent conversations with staff at CMS’ Central Office, it appears likely that the “other Non-Group Health Plan Medicare Set-Aside Arrangements” might include MSAs for liability settlements and potentially, a revision of the current workload review thresholds that would provide for the submission of WCMSAs under the current $250K settlement threshold for claimants within 30 months of eligibility.

CMS has indicated recently that they are in the process of revisiting the establishment of guidelines for Medicare Set-Asides for liability settlements. This process began back in June 2012 with an Advance Notice of Proposed Rule Making (“ANPRM”) in the Federal Register requesting comments and suggestions for options under consideration designed to meet payer obligations to protect Medicare’s interests with respect to future medicals in liability settlements. This effort was subsequently shelved in late 2014 due to CMS’ need to work through a multitude of system and workflow modifications necessitated by the implementation of the various functions required under the SMART Act. Currently, each regional office is left to decide whether they will review liability MSAs and any settlement amount thresholds for the same.

While it remains to be seen whether either or both of these changes come to pass, it appears clear that CMS feels it will likely impact the volume of MSA submissions the WCRC contractor receives under the new contract. We’ll keep you apprised of any new developments as we learn of them.

[To view the WCRC pre-solicitation, click here]

[A link to the original ANPRM announcement can be found here]

[For our prior blog posting concerning the SMART Act, click here]