CMS Releases Version 3.3 Workers’ Compensation Medicare Set-Aside Reference Guide

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on April 28, 2021
Posted by Shannon Flynn

by Crissy Sherman, CMS Operations Manager

Centers for Medicare and Medicaid Services (CMS) released a revised Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide Version 3.3 (dated April 19, 2021) late last week. Changes are detailed in Section 1.1 of the updated guide and include the following highlights, which may impact your claim management:

  1. Instructions for calculating the initial seed deposit required when funding a WCMSA with a structured settlement were clarified to note that the first surgery or procedure for each body part should be included
  2. Consent to Release documents must be signed and dated (by hand or electronically) with claimant’s full legal name

More detailed information regarding these changes is provided in the following sections.

Seed Money Calculation (Section 5.2)
For WCMSAs being funded via structured settlement, CMS has expanded their definition of what expenses are to be included in the initial deposit:

“an initial deposit is required to cover the first surgery or procedure for each body part, and/or replacement and the first two years of annual payments” (emphasis added).

During the Workers’ Compensation Review Contractor’s (WCRC) presentation at last year’s National Medicare Secondary Payer Network (MSPN) meeting, a discrepancy between industry perception and CMS representatives’ interpretation of seed money calculation was revealed. Attendees questioned CMS’ statements that the first surgery/procedure/replacement was to be included per body part, pointing to the former Reference Guide, which did not identify a “per body part” requirement. CMS reps stated that they would be reviewing/revisiting this language. Version 3.3 directly addresses this conversation.

Consent to Release (Section 10.2)
As you may recall, in April 2020 CMS amended release language that is required when submitting a WCMSA for review and approval. Version 3.0 required a Claimant to initial under a statement that they have reviewed and understand the intent process and administration.

In version 3.3, CMS has clarified that in addition to initialing under this statement, Claimants must also sign and date the bottom of the release with their full legal name. CMS will accept releases that have been properly initialed and signed electronically, as long as they meet the requirements of the E-SIGN Act. However, initials and signatures typed on the release (including those typed in a cursive font) are rejected by CMS. A version of a CMS compliant release can be found here.

In addition to the changes described above, another pertinent update involves a link to the updated Life Table.

Updated Life Table Link (Section 10.3)
In this latest version of the guide, CMS imbedded an updated link to the Center for Disease Control’s (CDC) current life table, Table 1: Life Table for the total population: United States, 2018, as noted in our blog last month.