CMS Publishes Updated WMCSA Reference Guide

October 30, 2019 // Elizabeth McCadden

CMS published an updated WCMSA Reference Guide on October 10, 2019, Version 3.0. This new version contains some changes throughout, but CMS has made several significant changes that workers’ compensation insurers and third-party administrators should be aware of. First, CMS has added an electronic attestation option for beneficiaries that are self-administering their WCMSA accounts as well as for professionally administered accounts. This new version continues to highlight CMS’ preference for professionally administered accounts and notes that CMS “highly recommends” professional administration of Medicare Set-Aside funds, especially when a claimant is taking “frequently abused drugs” according to CMS’ Part D Utilization Review (DUR) policy.

Additionally, Beginning on April 1, 2020, CMS requires all consent-to-release authorizations to include language indicating that the beneficiary reviewed the submission package and understands the WCMSA intent, submission process, and associated administration. This section of the consent form must include at least the beneficiary’s initials to indicate their validation.

Most significantly, CMS has extended the time period for submission of amended review requests from 48 months (4 years) to 72 months (6 years). Thus, it may be appropriate to take a fresh look at some older files where MSAs were submitted and approved in the past, medical has not settled and there has been a significant change in treatment to determine whether settlement of the medical is now feasible and appropriate.

Should you have any questions about the new WCMSA Reference Guide, or MSP compliance, please do not hesitate to contact Liz McCadden at