CMS is implementing important changes that impact how workers’ compensation Medicare Set-Aside (WCMSA) amounts are reported and how Amended Reviews are managed. These updates are outlined in the latest revisions to CMS’s user and reference guides.
Key Updates and Important Dates
- Effective April 4, 2025:
CMS has begun requiring Section 111 reporting for workers’ compensation MSAs for TPOC dates of April 4, 2025 and later. All relevant guides now reflect the updated WCMSA reporting requirements tied to this start date. - Elimination of the One-Year Waiting Period:
Previously, once an MSA was approved, a waiting period of one year was required before an Amended Review could be submitted. With the new changes, an Amended Review MSA can now be submitted at any time after approval as long as the other criteria are met.
What’s New in the CMS Guides?
Section 111 Mandatory Insurer Reporting User Guide (Version 8.0)
- Updated Field Numbers:
Field numbers have been updated throughout the user guide to align with the WCMSA reporting requirement effective April 4, 2025.
- Clarification on Reporting Thresholds:
In Chapter IV, under Technical Information (Section 6.4 – TPOC Reporting), the guide now clearly states that the $750 reporting threshold applies to non-trauma (alleged ingestion, implantation or exposure incident) no-fault as well as workers’ compensation cases.
- Additional MSA Correction Scenarios:
Three new scenarios have been added to the event table in Section 6.6.4. These are specific to errors or corrections linked to WCMSA reporting.
- Enhanced Appendices:
- The guide’s Appendices A, B, and G include updated reporting requirements. Notably, ZIP+4 guidance has been improved. Additionally, effective October 6, 2025, if an agent’s name is provided in the submission, the Recovery Agent TIN field is now mandatory.
WCMSA Reference Guide (Version 4.3)
- Settlement Notification Updates:
A “Notice of Settlement Received” letter has been introduced in Appendix 5. Whenever a WCMSA is reported, CMS will issue this letter to the claimant. This requirement applies even to MSAs that are not CMS-approved, ensuring that all claimants receive appropriate notification and that annual attestations are submitted for documented expenditures. - Streamlined Amended Review Process:
Along with removing the one-year wait, Sections 16.3 and 19.4 now clarify that the change of submitter policy applies to Amended Review MSAs as well. This allows for greater flexibility in managing and updating MSAs after they have been approved. See Tower article here on Amended Reviews.
WCMSA Self Administration Toolkit (Version 1.7)
- Reference-Only Guidance:
The toolkit now clearly states that it is a reference manual—not an exhaustive step-by-step guide—to assist users with WCMSA administration. - WCMSA Basics Introduction:
A new section introduces the fundamentals of WCMSA administration, making it easier for users to understand the process from the beginning. - Portal Access Instructions:
Detailed instructions and a screenshot now guide users on how to access the WCMSA portal on Medicare.gov for submitting their annual attestation. - Removal of the Inheritance Section:
The previously included section on what happens to the MSA funds after the Medicare beneficiary’s death has been removed. It is unclear why this was removed as it provided instructions on how the MSA funds are to be handled after the Medicare beneficiary dies (There remain instructions in Section 19.2 of the WCMSA Reference Guide on what happens to the MSA funds post-death).
Questions or More Information?
For any questions regarding these updates or for further assistance, you can reach out to Tower MSA Partners’ Chief Compliance Officer, Dan Anders, at 888.331.4941 or via email at daniel.anders@towermsa.com.
