WCMSA Reference Guide v4.7: Improved Submission Clarity Continues to Reinforce Voluntary Review
by S. Parker
WCMSA Reference Guide Version 4.7 was recently released by the Centers for Medicare & Medicaid Services (CMS), introducing a targeted update designed to improve communication with stakeholders when a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) submission is determined to be ineligible for review.
While this update does not introduce significant policy changes, it provides greater transparency within the submission process and, importantly, continues to reaffirm CMS’ longstanding position that participation in the WCMSA review process remains voluntary.
New “Ineligible – Other” Letter Added
The primary update in version 4.7 is the addition of a new “Ineligible – Other” letter. CMS indicates that the letter was created to address the numerous reasons a case may not qualify for review.
This enhancement should help carriers, self-insured employers, attorneys, and settlement professionals better understand why a submitted WCMSA was not accepted for review and reduce uncertainty when navigating the submission process.
This addition reflects the agency’s continued efforts to improve administrative efficiency and provide clearer communication to stakeholders without altering the underlying WCMSA review framework.
Reminder Regarding Open Medical Claims
The latest version of the guide continues to emphasize that a WCMSA should not be submitted when the settlement leaves medical benefits open and the workers’ compensation carrier retains Ongoing Responsibility for Medicals (ORM). In those situations, the carrier remains responsible for future injury-related medical expenses, making WCMSA review inappropriate.
Bottom Line
Version 4.7 is a modest but meaningful update. The addition of the new “Ineligible – Other” letter should improve communication and transparency surrounding ineligible submissions, while the revised language continues to clarify the purpose of the WCMSA review process.
Don’t hesitate to reach out to our Settlement Consultant team at [email protected] with any questions you may have regarding this WCMSA guide update or any Medicare Secondary Payer compliance issues.