Draft RFP for WCRC Released…Again.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on November 30, 2016
Posted by Jean S. Goldstein, JD, CMSP

CMS recently released a draft RFP for a new Workers’ Compensation Review Contractor (WCRC) to review WCMSAs once again.  The draft RFP can be found here (Solicitation No: RFP-CMS-2016-8A-0008). Comments on the proposed RFP must be submitted by December 7, 2016, with the official solicitation for a new WCRC to be released in December.  The award date is still set to be third quarter of 2017.

The draft RFP is also still noted as an 8(a) contract which means that bidding is limited to minority small businesses.  The proposed Statement of Work (“SOW”) provides some interesting statistics, indicating that the anticipated workload for a new WCRC will be approximately 1,600 new WCMSAs per month based on recent historical data.  The SOW also requires that the next contractor be ready to implement a new process for review of other Non-Group Health Plan MSAs, in the event that CMS chooses to do so.  The proposed review process would be similar to what currently exists for WCMSAs submitted.  However, per the SOW, the review would be broken down into two categories: a full review and a cursory review, based on settlement amounts.  Full review cases would be subject to a similar review process as currently implemented for WCMSA submissions, while a cursory review would only require that all required documents were provided for an amount determination to be made. This may mean that the expansion of MSA review to liability settlements, and potentially a change in CMS’ workload review thresholds may be on the horizon as previously reported.

The SOW also requires the new contractor to submit a transition plan detailing the steps and dates to assume the current WCRC’s workload.  Historically, case work for WCRC was broken down as 42% new cases, 56% of cases in some form of development, and 2% in re-review status.  With the possible expansion of review to include liability settlements and perhaps a change in the thresholds, the volume of MSA submissions and work load will surely increase.   The draft SOW also states that CMS hopes to reduce the number of cases in the development phase and requires the new contractor to provide a plan of action to reduce developments.  This certainly gives us some hope, as it was not too long ago when the current review contractor took over and issued an unreasonable amount of developments.

We will keep you updated as to any additional news and developments on the contract.