New information regarding upcoming Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) changes are posted as the information becomes available. Items remain on this page for the current year and are then moved to the Archive page.
June 3, 2014 - Updated WCMSA Reference Guide is Now Available
An updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide is now available in the Downloads section found at the bottom of this page.
The following sections of the Guide have been enhanced or added:
- 4.1.4 – Hearing on the Merits of the Case: Section added to reflect the April 22, 2003 WCMSA RO Memorandum (Question # 5).
- 9.4.4 – Medical Review – Step 8: Clarification of submission requirements for medical records and payment records.
- 10.8 – Section 40 – Payment History: Updated requirements for denied conditions.
- 126.96.36.199 – Pharmacy Guidelines and Conditions:
- Removed reference to Drug Tables for physician dispensed drugs.
- Consolidation of Drug Tapering and Drug Weaning sections.
- 10.5.2 – Use of WC Fee Schedule vs. Actual Charges for WCMSA: Wisconsin added to list of states with no Workers’ Compensation fee schedule.
- 10.7 – Section 35 – Medical Records:
- Removed two year requirement of medical records for unrelated to work injury.
- Clarified treating physician statements requirements.
- 10.8 – Section 40 – Payment History- Requirements for denied conditions.
April 10, 2014 - New WCMSA Self-Administration Page Now Available
A new WCMSA Self-Administration page has been added to the Workers Compensation Medicare Set-Aside Arrangement section of CMS.gov. The new page contains information for individuals who choose to self-administer their WCMSA accounts. Materials available on the new page include:
- New Self-Administration Toolkit for WCMSAs
- Account Expenditure for Lump Sum Account (Attestation Letter)
- Account Expenditure for Structured Annuity (Attestation Letter)
- Transaction Record Sample
- WCMSA Reference Guide
- Page last Modified: 06/10/2014 8:27 AM
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