CMS Releases WCMSA Self-Administration Toolkit Version 1.4

The word guide spelled out in wooden blocks

by B. Smith

On July 3, 2023, the Centers for Medicare & Medicaid Services (CMS) released an updated Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs), version 1.4. Below is a brief summary of key changes and updates to the Toolkit.

Section 1: Introduction
Defines appropriate exhaustion of the WCMSA, noting:

“Appropriately” means you spent this money on what it is supposed to be used on, and “exhausted” means the money has all been spent.

These terms are also defined in the glossary section of the Toolkit.

Section 12: Where to Get Help
Now notes that questions regarding setting up a WCMSA account or administering an account, can be made to the Medicare Regional Office (RO) customer service line, at 833-731-4677. The prior version of the Guide referred parties to the CMS website for a list of regional offices and separate contact information for each office.

Section 14: Glossary
CMS notes that ROs are now responsible for processing final settlement documents. This is consistent with the latest version of the WCMSA Reference Guide 3.9, which noted that ROs would no longer be responsible for initial WCMSA approvals.

The WCMSA Toolkit is often attached to settlement documents or referred to as part of the settlement when a claimant is self-administering a WCMSA. This serves as a resource for claimants and counsel post-settlement. However, in many cases, the Toolkit alone is not enough. Failure to properly administer WCMSA accounts after settlement can lead to potential exposure and denial of injury-related treatment.

Professional administration has been highly recommended by CMS for certain WCMSAs including those that include allocations for frequently abused prescription drugs and for claimants who cannot administer accounts on their own. Professional administration may also be prudent in a variety of cases depending on the amount and complexity of the WCMSA.

In many cases, claimants do not wish to utilize professional administration, or the case does not warrant it. However, assistance with a WCMSA post-settlement is still extremely valuable. Self-Administration with Support is an option for parties to consider on all WCMSAs as it provides claimants with a resource for all things WCMSA related including bill reviews post settlement, savings on durable medical equipment, prescription drugs and doctor visits, assistance with attestation statements, and other valuable services. It also helps prevent the premature exhaustion of WCMSA funds and helps claimants work through what can often be an extremely confusing process.

For questions regarding updates to version 1.4 of the Toolkit, or for more information about our post-administration services, please contact the IMPAXX Settlement Consultant Team at [email protected].