The Official Medicare Set Aside Blog And Information Resource

Sublocade – A New Once-Monthly Injection for the Treatment of Opioid Use Disorder

CMS, FDA, Medicare, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on February 5, 2018 | Posted by Katherine Bales

The opioid crisis continues to be one of the most talked about issues facing the health care community, and the nation as a whole, having been declared a national public health emergency. In response, pharmaceutical companies have been actively working on ways to treat the crisis with the development of alternative treatment methods. The FDA […] Continue

WCRC Award Protests Denied

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on December 18, 2017 | Posted by Jean S. Goldstein, JD

As we previously reported, CMS awarded the Workers’ Compensation Review Contractor (WCRC) contract to Capitol Bridge, LLC, which was subsequently protested by two other companies who participated in the bidding process.  The protests were recently denied, but the decisions are covered by protective orders and must be redacted before being published.  Once available, the decisions […] Continue

CMS to Begin Utilizing 2014 Life Table

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on December 13, 2017 | Posted by Jean S. Goldstein, JD

The CMS WCMSA web portal, where Workers’ Compensation Medicare Set Aside submissions are submitted to CMS for review, has alerted users that as of December 11, 2017, CMS will begin using the Table 1: Life Table for the total population: United States, 2014.  This means that for any WCMSA proposal received by CMS, or where […] Continue

Change is Needed: CWCI Study Provides Concrete Evidence of Over Inclusion of Opioids in WCMSAs

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Opioids, Rx/Pharmacy on November 3, 2017 | Posted by Jean S. Goldstein, JD

This week, the California Workers’ Compensation Institute (CWCI) released a study documenting opioid use in Workers’ Compensation Medical Set-Asides (WCMSAs).  The study (for which MEDVAL contributed both data and advice concerning MSAs) focused on a specific dataset of CMS approved California WCMSAs from 2015 and 2016, against a control group of claims from 2006 through […] Continue

CMS Considering Voluntary Review of Liability MSAs, Again

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on October 26, 2017 | Posted by Jean S. Goldstein, JD

On October 26, CMS once again issued an alert indicating it would be considering expanding the review of voluntary Medicare Set-Asides (MSAs) to include liability insurance and no-fault insurance (LMSAs and NFMSAs).  Just as with other alerts, today’s alert also states that CMS will work closely with the stakeholder community to identify how best to […] Continue

NEW Workers’ Compensation Review Contractor (WCRC) Contract Awarded

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on September 5, 2017 | Posted by Jean S. Goldstein, JD

Finally, a new Workers’ Compensation Review Contractor (WCRC) award has been issued.  This news comes after several months of work being completed by Provider Resources, the incumbent contractor, under an expired contract.  The new WCRC contract was awarded on September 1, 2017 to Capitol Bridge, LLC of Arlington, Virginia, a certified small business entity.  Capitol […] Continue

Settling a Case in Arizona?  What You Need to Know About Full & Final Settlements

Medicare Set-Asides, MSP News, State Regulations on August 3, 2017 | Posted by Jean S. Goldstein, JD

Historically, workers’ compensation claims in Arizona have been subject to a number of limitations.  If additional medical treatment was needed, a claimant could reopen a claim at any time, despite the finality and resolution of the claim.  As a result, settlement of workers’ compensation claims in Arizona have been far less common because these claims […] Continue

New WCMSA Reference Guide Issued

CMS, Medicare, Medicare Set-Asides, MSP News, Re-Review Process on August 1, 2017 | Posted by Jean S. Goldstein, JD

As you may be aware, on July 10th, here on our blog we announced the quiet release of a change to CMS’ re-review process.  However, as we noted at that time, this process was not formalized by CMS, and had simply been released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP).  Specifically, through a revised WCMSAP User Guide, […] Continue

Eyes on the Prize: A New CMS Re-Review Option is Available.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on July 10, 2017 | Posted by Jean S. Goldstein, JD

While all eyes (and ears) have been focused on the news, or the lack thereof of news regarding the Workers’ Compensation Review Contractor award, CMS quietly released a change to their re-review process today.  The change was released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP).  Specifically, through a revised WCMSAP User Guide, which can […] Continue

Will the WCRC Award Be Announced Tomorrow?

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, WCRC on June 29, 2017 | Posted by Jean S. Goldstein, JD

Tomorrow is June 30.  Per the Centers for Medicare & Medicaid Services (CMS), we are expecting that the Workers’ Compensation Review Contractor (WCRC) award will be announced tomorrow.  The WCRC is the entity responsible for projecting future medical costs that would otherwise be reimbursable by Medicare, for those cases submitted as related to a workers’ […] Continue