CMS Releases Revised User Guide for WCMSAs

CMS just released a newly-revised WCMSA User Guide.  The revisions include:

-  Addition of Section 4.1.4 concerning Hearings on the Merits of Cases;

- Clarification of initial submission requirements for medical records and payment records;

-  Miscellaneous modifications including removal of a reference to Drug Tables for physician-dispensed drugs and combination of User Guide sections on Drug Tapering and Drug Weaning;


-  Addition of Wisconsin to the list of states with no WC fee schedule; and

-  Addition of Appendix 6 which lists changes made in previous versions of the WCMSA User Guide.

The newly added section 4.1.4 provides as follows concerning a Hearing on the Merits of a Case:  

When a state WC judge approves a WC settlement after a hearing on the merits, Medicare generally will accept the terms of the settlement, unless the settlement does not adequately address Medicare’s interests. If Medicare’s interests were not reasonably considered, Medicare will refuse to pay for services related to the WC injury (and otherwise reimbursable by Medicare) until such expenses have exhausted the dollar amount of the entire WC settlement. Medicare also will assert a recovery claim if appropriate.

If a court or other adjudicator of the merits (e.g., a state WC board or commission) specifically designates funds to a portion of a settlement that is not related to medical services (e.g., lost wages), then Medicare will accept that designation.

Let us know if you have any questions concerning these revisions.  To access the complete, revised WCMSA User Guide, click here.