Catching Up With Workers’ Compensation Medicare Set-Aside Arrangements

Changes to Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs) are made regularly to ensure that WCMSAs can act appropriately across a wide array of different cases. If your client has suffered a workplace injury, you’re undoubtedly up to your neck in legal literature. Before your client can procure their award, you have to win their case. In many cases, it’s hard to focus on both without enlisting a consultant who can offer your client Medicare set aside services. If you want to help your client win their case, it’s important to stay updated on WCMSA rules and regulations.

Revised Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide

The WCMSA Reference Guide was updated to version 2.6 midway through 2017. It can be found on the Centers for Medicare and Medical Services (CMS) website. It helps clarify existing policies and expands the criteria for WCMSA re-review submissions. Submitters can now request a re-review where CMS has already issued an amount, but the settlement is still pending and the approved medical care cost has changed. This revision also helped clarify how to work with states that use Utilization Review processes to defend prospective WCMSA amounts.

Consideration for Expansion of Medicare Set-Aside Arrangements (MSA)

CMS continuously alters and expands its voluntary Medicare Set-Aside Arrangements (MSA) review process to incorporate liability insurance and no-fault insurance MSA. To facilitate this expansion, CMS works closely with stakeholders to determine the best course of action for implementing the future expansion of voluntary MSA reviews.

Use of the Center for Disease Control (CDC) 2014 Life Tables

The Centers for Medicare and Medical Services (CMS) is now using CDC’s Table 1: Life Table for the total population: United States, 2014 as a metric for WCMSA life expectancy calculations.

WCMSAs and Opioids

CMS is well aware of the opioid crisis crippling the United States, and they’ve updated their considerations to better operate within the framework of the current problem. To ensure that the determination of WCMSA amounts adequately covers claimants’ needs for future medical services and medicine is suitable, CMS evaluates related policies and procedures on an ongoing basis.

WCMSA is constantly updated to better reflect the current state of American healthcare. Managing to keep up with every bit of news can be a daunting task, and your client will most likely suffer without a skilled consultant to assist you with the process of procuring a medicare set aside for personal injury.

For more information or to schedule a consultation, please submit our contact request form.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.


"In my twenty-two year career as a trial lawyer I've handled my share of catastrophic cases and structures, but imagine the complexity of an engaged, unwed mother catastrophically injured during delivery, giving birth to a healthy child, but left in a vegetative state? The issues of guardianship and entitlements of the newborn, the rights of the biological father-fiancé, an out-of-state teenage child of the mother, lifetime maintenance of the mother, as well as the rights of family of the mother, who became her primary care-takers? Synergy systematically managed the seven figure tender of one defendant, the establishment of a Qualified Settlement Fund, a Special Needs Trust, and multiple structures, all the while concurrently maintaining the various entitlements to ancillary services, as well as the remaining litigation. Everything was handled professionally, timely and literally without a hitch. Truly an amazing feat."

Marcus J. Michles II
Michles & Booth

"I have used Synergy to resolve tough Medicare lien and set aside issues. There is no other practice that comes close to the quality of their work. I highly recommend them and they are a must for the substantial, tough cases."

Mark R. Hanson
LaBovick Law Group

WordPress Image Lightbox