In situations where Workers’ Compensation benefits are fully commuted as a result of a settlement, Medicare does not have to pay for future related medical care that it otherwise would normally pay for.
CMS believes that a Medicare Set Aside is the best method to protect its future exposure.
Medicare has published quite a few policy memorandum on items that need to be considered when protect its future exposure in a Workers’ Compensation matter and additional memorandum on the development of a WCMSA including when Medicare will review and WCMSA and how to administer and fund a WCMSA. The CMS policy memorandum listed below detail the following topics related to WCMSAs:
- No Medicare Payments for a Claimant’s Work-Related Injury or Disease until the WCMSA has been Exhausted (Ref: 7/23/01 Memo)
- No Compromise of Future Medical Expenses (Ref: 7/11/05 Memo Q11)
- No Waivers of Specific Services Related to a WC Case (Ref: 4/21/03 Memo Q18)
- WC Claims Not Covered in the Settlement (Ref: 4/21/03 Memo Q16)
- Loss of Medicare Entitlement after CMS Approval of a WCMSA (Ref. 7/11/05 Memo Q9)
- Effect of WCMSA on Medicaid Eligibility (Ref: 7/11/05 Memo Q13)
- Use of WC Settlement Funds Prior to Medicare Entitlement (Ref: 7/11/05 Memo Q3)
- WCMSAs in Cases Where There are Both a WC Claim and a Third Party Liability Claim (Ref: 4/21/03 Memo Q19)
- Review of a WCMSA
- Administering a WCMSA
- Funding a WCMSA
- Upon submission of our intake form we will prepare a WCMSA Allocation report.
- By request we will communicate with the treating physicians regarding recommended care.
- If the case meets CMS’ review criteria (WC is fully commuted and the client is either on Medicare and the claims settled for more than $25,000 or the client has the reasonable possibility of going on Medicare within 30 months and the claim settled for more than $250,000) we will submit the MSA to Medicare for their review.
- We will educate the client in regards to administering and funding the MSA.
- We will have the client sign a release stating they have been advised to set aside funds.