CMS Issues Revised WCMSA Self-Administration Toolkit, Version 1.2

CMS, Medicare Set-Aside Blog, MSP News on May 7, 2018
Posted by Jean S. Goldstein, JD, CMSP

The Centers for Medicare & Medicaid Services (CMS) recently issued a revised self-administration toolkit, version 1.2. The purpose of the toolkit, just as with the previous version is outlined on page 3 of the 31 page guide, which is to describe the Workers’ Compensation Medicare Set-Aside (WCMSA) self-administration process and provide guidelines for claimants. 

Specifically, the toolkit:

  • Describes the self-administration process, from when the account is first established until all of WCMSA funds have been used;
  • Explains who a claimant will work with to manage their WCMSA account;
  • Discusses the two types of WCMSA accounts (lump sum and structured);
  • Covers special circumstances, such as when a Medicare beneficiary’s status changes.

The revised toolkit includes some minor revisions, which include:

  • The addition of the word ONLY to the following sentence: “You will ONLY use the funds from this account to pay your future medical treatment and prescription costs related to the WC injury”;
  • The addition of Medicare premiums noted as an expense for which the WCMSA account may not be used; and
  • Removal of the section “How should my health care providers calculate the bill?”

The section “How should my health care providers calculate the bill?” previously advised that the claimant would need to know whether the WCMSA was established based on actual charges for medical treatment or if the WCMSA was funded on a state workers’ compensation fee schedule, and that prescription medications should be billed based on Red Book Average Wholesale Price.  The previous version of the toolkit also specifically indicated that regardless of how the physician bills, the WCMSA funds should be used to pay for treatment. Thus, knowing the calculation method of the WCMSA really had no bearing on a claimant’s obligation to pay a physician’s bill.

We have steadily been awaiting additional scrutiny from CMS with respect to administration of WCMSAs.  Recall that last year, CMS stated that “[a]lthough beneficiaries may act as their own administrators, it is highly recommended that settlement recipients consider the use of a professional administrator for their funds.”  This statement made us question whether CMS would begin to scrutinize self-administrated WCMSAs more closely or ask claimants to provide the itemized receipts, or other proof of payment CMS indicates must be retained.  CMS has made it abundantly clear that professional administration is certainly in a beneficiary’s best interests.  Simply going through this toolkit can be a daunting task for a claimant.  In addition, claimants may be unable to navigate payment arrangements with their medical providers, all while determining which treatment received is Medicare-covered, and which treatment is not.  It is no wonder that CMS has highly endorsed professional administration, as it simply requires that the claimant obtain the medical treatment they need; and the professional administrator handles the rest.  While CMS’ self-administration toolkit is an available resource for claimants, it certainly does not make the entire process any easier.  To download the revised toolkit, click here.


MEDVAL offers full service and highly attentive administration of MSA accounts, providing a claimant with confidence that his or her claim is being handled expeditiously and appropriately.  For more information about our professional administration program, please contact us at 877-MSA-ADMIN (877-672-2364) or