On September 1, 2017, the Centers for Medicare and Medicaid Services (CMS) announced the awarding of the contract for the Workers Compensation Review Contractor (WCRC) to Capitol Bridge, LLC. The $60 million contract is for one-year with the option of renewing for an additional four years.

Since 2003, CMS has had in place the WCRC for the purpose of reviewing Workers’ Compensation Medicare Set-Aside (WCMSA) proposals submitted to CMS for review and approval. The WCRC evaluates these proposals and provides a recommendation to the designated CMS Regional Office (RO) as to whether the proposed MSA amount adequately protects Medicare’s interests. If the WCRC disagrees with the proposal it will provide an alternate recommendation, either higher or lower, than the proposed amount. The CMS RO usually accepts the recommendation from the WCRC and issues the approval letter to the submitter of the proposed MSA.

Provider Resources, Inc., has been the WCRC for the past five years. It is unclear based upon the available information when Capitol Bridge will take over from Provider Resources, although the solicitation for the WCRC contract provided for a three-month transition period.

Tower MSA Takeaways

It is important to note that while the review contractor may change, the policies in place to review WCMSAs are set by CMS, not the contractor. Consequently, we do not anticipate any significant change to how WCMSAs are reviewed and approved under the new contractor. Nonetheless, there are some recent changes to the WCMSA Reference Guide, such as the Amended Review process, which will fall largely on Capitol Bridge to implement (See article: Practical Implications of the Revised CMS WCMSA Reference Guide). Also, as we advised in another article, CMS MSA Review Expansion to Liability Planned for 2018, the new WCRC contract provides for an optional expansion of the WCMSA review process to liability claims as of 7/1/2018. At this time, it is uncertain whether CMS will choose to move forward with such an expansion as of that date.

Given our experience with other CMS contractor transitions we anticipate the new contractor will have a learning curve, which may result in longer turnaround times for MSA submissions and some responses inconsistent with the prior contractor’s reviews. Tower MSA will, if necessary, address with CMS any WCMSA approval falling outside of established CMS guidelines.

We look forward to working with Capitol Bridge over the coming months and years to provide for an effective WCMSA review and approval process that benefits all interested parties. Tower MSA will continue to provide any relevant updates as Capitol Bridge transitions to its role as the WCRC.