CMS’s Revised Consent to Release Form Becomes Mandatory April 1

March 18, 2020

illustration of Revised Consent to Release form signing

As of April 1, 2020, submissions of Workers’ Compensation Medicare Set-Asides (WCMSAs) must include CMS’s revised Consent to Release form.  The form indicates that the need and process for the WCMSA have been explained to the injured worker, and that the injured worker has approved the contents of the submission, including the allocated funds.

First announced with the release of an updated WCMSA Reference Guide on October 10, 2019 (Version 3.0), the revised consent must include the following language:

Further, I have had the Workers’ Compensation Medicare Set-Aside Arrangement need and process explained to me, and I approve of the contents of the submission.

Beneficiary Initials: ____

A copy of the revised consent to release can be found here.

Practical Implications

If the claimant is represented by an attorney, the attorney will typically explain why an MSA is needed in settlement of their WC case.  If not represented, this responsibility may fall to the adjuster or defense attorney.

CMS provides resources to assist with the MSA explanation in both the WCMSA Reference Guide and the Self-Administration Toolkit.  Additionally, for professionally administered MSAs, our partner Ametros provides general information as well as individual consultation to walk the injured worker through how the MSA will work post-settlement.

As mentioned above, the revised consent requires the claimant to approve the contents of the MSA submission.  While a review of the MSA report alone by the claimant or their attorney may be enough to obtain the beneficiary’s approval, if the injured worker requires additional documentation prior to their approval, Tower will provide it.

Finally, keep in mind, consent without the revised Consent to Release language will no longer be valid as of April 1.  Consequently, Tower may provide a revised consent form to be executed by the claimant prior to submission or resubmission of the MSA to CMS.

If you have any questions please contact Tower’s Chief Compliance Officer, Dan Anders, at (888) 331-4941 or