Workers Compensation Agency Services

What's New

April 2, 2013 – CMS.Gov Web Site Redesign

The Coordination of Benefits and Medicare Secondary Payer Recovery sections on the Medicare tab of the CMS.gov Web Site are currently being redesigned and restructured.

The first phase of this reorganization is to the Workers’ Compensation Agency Services Section which will be replaced by the Workers’ Compensation Medicare Set-Aside Arrangement section.  Please continue to check this web site for updates.

April 1, 2013 - Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Town Hall  Event

The CMS will be hosting a WCMSA teleconference on April 11, 2013. This event will provide stakeholders an opportunity to learn more about the Workers’ Compensation Review Contractor (WCRC), and discuss procedural matters that are not case specific.

In an effort to address as many topics as possible, CMS is requesting stakeholders to submit non-case specific questions they would like to have addressed during the teleconference to the CMS MSP Central mailbox* prior to the teleconference. CMS will review and categorize the questions submitted and attempt to answer as many questions as possible during the teleconference. There may also be an opportunity for the stakeholders to ask questions after the presentation.

Date of Teleconference:   April 11, 2013

Call-in time for all calls:    2:30-4:30p.m. EST

Call-in line:                      (800) 603-1774

Pass Code:                      WCRC

Questions for call:            Please submit to CMS mspcentral@cms.hhs.gov*

Questions may be submitted beginning April 1, 2013 thru April 5, 2013 @ 3:30 p.m. EST.

All questions submitted for the teleconference to the email address shown above should clearly state in the subject line “WCRC April 11, 2013 Town Hall Teleconference.”  

Note: Questions submitted to the mailbox after the date and time noted above will not be considered.

March 29, 2013  

A new Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available in the Downloads section found at the bottom of this page. This reference guide was created to consolidate  information currently found within the Workers’ Compensation Agency Services webpages and CMS Regional Office Program Memorandums, while providing WCMSA information to attorneys, Medicare beneficiaries, claimants, insurance carriers, representative payees, and WCMSA vendors.   Please continue to visit this website for future updates to the reference guide, including additional details regarding the Workers’ Compensation Review Contractor’s review process.

February 12, 2013

Effective immediately, if a WCMSA proposal amount was originally submitted via the web-portal,  a re-evaluation of an approved WCMSA amount can be requested through the WCMSA web portal, if the claimant or submitter believes that a CMS determination:

• contains obvious mistakes, such as mathematical errors or a failure to recognize that medical records already submitted show a surgery CMS priced has already occurred, or

• misinterpreted evidence previously submitted, a re-evaluation maybe requested.  

Please refer to  Question # 12 of the July 11, 2005, procedure memorandum located in the “downloads” section of this page for detailed information regarding when a  re-evaluation request maybe submitted.  The CMS Regional Offices will continue to review the requests submitted through the portal.

January 15, 2013

There will be a delay in uploading a courtesy link to the Centers for Disease Control (CDC) 2008 United States Life Tables on this page.  However, CMS will begin referencing the CDC's   Table 1: Life table for the total population: United States, 2008, for WCMSA life expectancy calculations on January 19, 2013. The URL listed below the end of this sentence may be used to view the 2008 CDC Life Tables.  We will continue to work toward adding the link to the CDC's 2008 Life table to this page.

December 17, 2012

The Centers for Disease Control (CDC) has published its 2008 United States Life Tables. Effective January 19, 2013, the Centers for Medicare & Medicaid Services (CMS) will begin referencing the CDC's Table 1: Life table for the total population: United States, 2008, for WCMSA life expectancy calculations. This means that for any newly submitted WCMSA proposal received by CMS' Coordination of Benefits Contractor (COBC), uploaded via the Web portal, or where any WCMSA case is reopened on or after January 19, 2013, CMS will apply the CDC's 2008 Table 1 for life expectancy calculations.  As a courtesy, a link to the CDC's United States Life Tables 2008 will be provided, at a later date, in the related links section outside of CMS section of this page.

November 4, 2012

The Workers’ Compensation Case Control System (WCCCS) and the Workers’ Compensation Medicare Set-aside Portal (WCMSAP) are currently operational. The Workers' Compensation Review Contractor (WCRC) has resumed its duties. Thank you for your patience during this natural disaster.     

October 31, 2012

Due to the recent hurricane that impacted the East Coast of the United States of America, the Workers’ Compensation Case Control System (WCCCS) and the Workers’ Compensation Medicare Set-aside Portal (WCMSAP) are currently not operational.  We are working diligently to restore these systems.  We will provide additional updates to all stakeholders, via this web site, as warranted.

September 13, 2012 

The Centers’ for Medicare and Medicaid Services (CMS) has received a number of inquires regarding proposals previously submitted to the Agency.  Please be assured that the Workers’ Compensation Review Contractor (WCRC) is reviewing proposed WCMSA amounts submitted to CMS prior to July 2, 2012.   We are confident that submitters, Medicare beneficiaries and other program stakeholders will soon begin to see an increase in CMS’ communications regarding WCMSA proposals dated prior to July 2, 2012, and after. The CMS strives to provide all WCMSA stakeholders the best customer service possible; and CMS is continually working to improve the WCMSA process.     

August 9, 2012

Information regarding the application of  CMS' recent determination related to TENS Units for Chronic Low Back Pain(CLBP) and the WCMSA review process has been posted, as a download document, to the WCMSA- Related Topics page.   

June 22, 2012

Effective July 2, 2012, you may contact the Workers' Compensation Review Contractor (WCRC) at its NEW toll free telephone number 1-855-280-3550. The WCRC's hours of operation will be 9:00am to 5:00pm EST, Monday thru Friday.    

December 27, 2011

Address for submitting annual accounting documentation to CMS' Medicare Secondary Payer Recovery Contractor (MSPRC). Please send your completed annual Workers' Compensation Medicare Set-aside Arrangement (WCMSA) Account Expenditure accounting documentation to the CMS lead Medicare Contractor at the address below:

MSPRC - Non-Group Health Plan (NGHP)
P.O. Box 138832
Oklahoma City, OK 73113

December 7, 2011

The Workers' Compensation Medicare Set-aside Portal (WCMSAP) application has gone “live” and is now available for users. Prior to attempting to register, you should read the New Registration section of the User guide. The URL for the WCMSAP may be found under the "Related Links Outside CMS," on the WCMSAP section page. The WCMSAP User Guide may be found in the "Reference Material" section of the WCMSAP application.

Instructions on how to register for the Computer Based Training (CBTs) may be found in the “Workers' Compensation Medicare Set-aside Portal (WCMSAP) Computer Based Training (CBT) document under the “Downloads Links” on the WCMSAP section page (click the “How to Register for WCMSAP Computer Based Training (CBT) Modules hyperlink.”) These courses are designed to assist submitters of Workers' Compensation Medicare Set-Aside Arrangements (WCMSAs) with the registration and use of the WCMSAP.

October 4, 2011

The Centers for Disease Control (CDC) has recently published its 2007 United States Life Tables. Effective October 31, 2011, the Centers for Medicare & Medicaid Services (CMS) will begin referencing the CDC's Table 1: Life table for the total population: United States, 2007, for WCMSA life expectancy calculations. This means that for any newly submitted WCMSA proposal received by CMS' Coordination of Benefits Contractor (COBC), or where any WCMSA case is reopened on or after October 31, 2011, CMS will apply the CDC's 2007 Table 1 for life expectancy calculations. You may access the CDC's United States Life Tables in the related links outside of CMS section of this page.

May 13, 2011

The May 11, 2011 memorandum reiterating CMS'  current workload review thresholds has been posted. This memorandum is accessible under the "Related Topics" page of this website. 

August 11, 2010

An updated Top Ten Submitter Error document has been provided under the WCMSA Related Topics page.   

June 15, 2010

Posted memorandum clarifying the guidance provided in the Centers for Medicare & Medicaid Services (CMS) May 14, 2010 procedure memorandum regarding the Rated Age (RA) language to be included on WCMSA proposals. This memorandum is accessible under the "Related Topics" page of this website.

May 25, 2010

The May 14, 2010, procedure memorandum, located on the Related Topics Page of this website, requires that new, specific rated age language accompany all WCMSA proposals submitted to CMS for review.  The new rated age statement must be presented with all WCMSA proposals submitted on or after June 1, 2010.

May 19, 2010

Posted procedure memorandum that clarifies guidance previously provided in the Centers for Medicare & Medicaid Services' (CMS') April 3, 2009 and July 1, 2009 procedure memoranda regarding prescription drugs administered to Medicare beneficiaries for off-label and/or unlabeled outpatient uses. The May 14, 2010 procedure memorandum clarifies whether these drugs are considered covered by Medicare Part D and, therefore, appropriately included in a Medicare Workers' Compensation Set-aside Agreement (WCMSA) proposal. This memorandum also changes the Rated Age (RA) language to be included in WCMSAs, as detailed in the August 25, 2008 procedure memorandum.

Posted the April 22, 2010 updated version of the WCRC Operating Rules, which are accessible under the “Related Topics” page of this website.

Note: Please be advised that policies, procedures, and or guidelines issued by CMS are not official until they have been posted for the public on CMS' official web site.

December 14, 2009

The section of text on the Overview page referencing CMS' Policy memorandums has been deleted.

The CMS policies, procedures and guidelines can be found at the links below under Downloads and the “WCMSA - Related Topics” section page under Downloads.

Since the updated sample submission incorporates the WC checklist, on the “Submissions of WCMSAs” section page, the WC Submission Checklist Download has also been deleted.

September 25, 2009

Updated sample submission/checklist, which takes into consideration the pricing of prescription drugs. Click on the "Submission of WCMSAs" section page and scroll down to the bottom of the page to "Downloads" to see updated sample submission/checklist.

Section 111

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (PL 110-173) amends the Medicare Secondary Payer (MSP) provisions of the Social Security Act (Section 1862(b) of the Social Security Act; 42 U.S.C. 1395y(b)) to provide for mandatory reporting for group health plan arrangements, liability insurance (including self-insurance), no-fault insurance, and workers' compensation. The provisions will be implemented January 1, 2009, for information about group health plan arrangements, and July 1, 2009, for information about liability insurance, no-fault insurance, and workers' compensation.

To be directed to the "Mandatory Insurer Reporting" web page, copy and paste the address below into your URL address bar:

https://www.cms.hhs.gov/MandatoryInsRep/

WCMSA submission address effective August 27, 2007 

CMS
c/o Coordination of Benefits Contractor
P.O. Box 33849
Detroit, MI 48232-5849

This section will provide you with information on the Coordination of Benefits (COB) program and assist you with meeting your responsibilities and obligations under the Medicare Secondary Payer (MSP) laws in regard to Workers' Compensation (WC) issues. This section is divided into the following web pages:

• Introduction to WC
• Reporting a WC Case and Obtaining Conditional Payment Information
• Workers' Compensation Medicare Set-aside Arrangements (WCMSAs)
• Submissions of WCMSAs
• Review Process of WCMSAs
• Administering WCMSAs
• WCMSA-Related Topics
• Part D of the Medicare Modernization Act and WCMSAs
• WC Data Match
• WC Agency Outreach