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New WCMSA Reference Guide

October 11, 2021 · New WCMSA Reference Guide

The Centers for Medicare and Medicaid Services (CMS) released Version 3.4 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide. Published on October 5, 2021, Version 3.4 adds language to help ensure that funding information is provided for the WCMSA amount as part of a settlement agreement.

10.5 Section 25 – Settlement Agreement or Proposed or Court Order now states, “However, approval of the WCMSA is not effective until a copy of the final executed WC settlement agreement, which must include the funding information for the WCMSA amount, is received by CMS.”

The above noted change has also been added to the CMS approval and Development sample letters found in Appendix 5 of the WCMSA Reference Guide stating that funding information must be included in the final executed workers’ compensation settlement agreement.

In addition, to align with updates to the MyMedicare.gov site, all references to MyMedicare.gov have been changed to Medicare.gov, which is updated in Section 17.7 Medicare.gov link in the WCMSA Reference Guide.

These additions and clarifications are relatively minor changes to the WCMSA Reference Guide. Optum Settlement Solutions will continue to keep the industry updated on all aspects of Medicare Secondary Payer (MSP) compliance, including issues pertaining to WCMSAs.


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