CMS Issues Revised Self-Administration Toolkit for WCMSAs, Version 1.3

CMS, Medicare Set-Asides, Professional Administration on October 18, 2019
Posted by Jean S. Goldstein, JD, CMSP

The Centers for Medicare & Medicaid Services (CMS) issued a revised Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside (WCMSA) Arrangements, version 1.3 yesterday. The purpose of this toolkit is to describe the WCMSA self-administration process and provide guidelines for claimants who are administering their own WCMSA.  Specifically, the toolkit:

  • Describes the self-administration process, from when the account is first established until all of the 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); and
  • Covers special circumstances, such as when a Medicare beneficiary’s status changes.

The revised toolkit includes revisions to reflect the new portal enhancement related to electronic attestations, which we recently discussed here on our blog, and specifically notes,

“If you are a beneficiary administering your own account, you can submit your yearly attestation online by accessing the WCMSA Portal through the MyMedicare.gov website. If you are a representative or other identified administrator for the account, you can log in directly to the WCMSA Portal to submit the yearly attestation. To access, go to https://www.cob.cms.hhs.gov/WCMSA/.  The WCMSAP User Guide, available under the Reference Materials header once you log in to the site, has details about submitting your attestation online. The wording on the forms is the same as you will find later in this toolkit.”

Of note, even with this new electronic feature, annual attestations can still be mailed to CMS. 

In addition, the toolkit also makes another significant change in Section 10 (page 10), with respect to the death of an individual with a WCMSA account, prior to complete exhaustion of the WCMSA account.  The toolkit now clarifies that the BCRC should be advised of the death, and that the,

“Medicare Regional Office (RO) and the BCRC will make sure that all bills related to the WC claim have been paid. This may involve holding the WCMSA open for some time after the date of death, as health care providers can submit their first bill to Medicare up to 12 months after the date of service. Then any amount left over in the WCMSA may be paid out according to state law, once Medicare’s interests have been protected. Often, the settlement itself will state how to spend funds after the death of the claimant and payment of care related expenses.”

This is an important practice tip for those who may be WCMSA account beneficiaries, or those who act in the capacity as an administrator, as well as estate administrators to be aware of prior to closing any WCMSA account.   The toolkit is also a very helpful resource to provide to a claimant or claimant’s counsel with at the time of settlement, as a resource to understand how to meet Medicare Secondary Payer obligations post-settlement. 

CMS is finalizing the new electronic attestation feature, and will be hosting two upcoming webinars to highlight the new process.  Please be sure to check back for a full summary following the webinars.