CMS Reinforces Need for Administration and Medicare Coordination in WCMSA Reference Guide Version 4.6

by M. Heberling

On July 13, 2026, the Centers for Medicare & Medicaid Services (CMS) released an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide version 4.6. This updated guide contains revisions that reinforce the importance of proper WCMSA administration and post-settlement compliance.

Approval Letter Updates
CMS added new language to the sample Approval Letter in Appendix 5 addressing structured WCMSAs. The revised letter explains that unused annual funds must remain in the WCMSA account for future injury-related treatment and that Medicare may pay for covered services when available annual WCMSA funds have been properly exhausted. CMS also instructs beneficiaries to pay bills in the order they are received to help the Benefits Coordination & Recovery Contractor (BCRC) confirm the funds were properly spent for that year.

Language was also added to advise beneficiaries that CMS will notify Medicare Advantage Part C and Part D plans when a WCMSA has been approved but will not provide those plans with detailed information regarding the specific treatment or medications covered by the WCMSA. As a result, Part C and Part D plans may contact beneficiaries (or their administrators) to determine which expenses should be paid through the WCMSA. CMS further warns that a beneficiary’s failure to respond to these inquiries could result in delays or interruptions in coverage.

Lastly, CMS made several other revisions to the Approval Letter, including:

• • Identifying the state workers’ compensation fee schedule used in calculating the WCMSA allocation
  • Updating the fax number for submission of the settlement agreement (10 pages or less)
  • Revising the mailing address for annual attestations
  • Directing inquiries on the CMS Approval Letter to the Regional Office Customer Service

Notice of Settlement Received Letter Updates
Language was also added to the sample Notice of Settlement Letter in Appendix 5. It is important to note that CMS has been sending these Notice of Settlement letters to beneficiaries based on their settlement or Total Payment Obligation to Claimant (TPOC) being reported through Section 111. These letters are not specific to situations involving a CMS’ approved MSA but also include settlements that utilize a non-submit MSA.

CMS added the same language as in the sample Approval Letter. They advise beneficiaries that they will inform Medicare Advantage Part C and Part D plans when a WCMSA has been approved but will not provide detailed information regarding the specific treatment or medications covered by the WCMSA. They also indicated that Part C and Part D plans may contact beneficiaries, or their administrators, due to a failure to respond, which may cause delays or interruptions in coverage.

Key Takeaway
Notably, CMS continues to focus on post-settlement compliance. The updated correspondence places emphasis on beneficiary responsibilities, proper administration of WCMSA funds, and coordination of benefits. The addition of Medicare Advantage and Part D language is particularly noteworthy, as it reflects CMS’ ongoing efforts to expand coordination beyond traditional Medicare Parts A and B. Carriers and self-inured employers involved in workers’ compensation settlements should review the updated guidance and confirm their settlement and administration processes align with CMS’ expectations.

If you have questions regarding WCMSA Reference Guide Version 4.6, WCMSA administration, or Medicare Secondary Payer compliance strategies, please contact the IMPAXX Settlement Consulting team at [email protected].