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What's New

New information regarding upcoming Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) changes are posted as the information becomes available.  Items remain on this page for the current year and are then moved to the Archive page.

December 14, 2017 - WCMSAs and Opioids

CMS understands the concerns regarding the opioid crisis occurring in the United States. We are committed to ensuring the determination of Workers’ Compensation Medicare Set Aside Arrangement (WCMSA) amounts are an adequate projection of claimant’s needs for future medical services and prescription drugs. CMS continually evaluates all policies and procedures related to WCMSA amounts. Any changes that Medicare pursues related to this issue will be reflected in our WCMSA amount review process. 

More information on the WCMSA process can be found in the WCMSA Reference Guide.

December 11, 2017 - Use of the Center for Disease Control (CDC) 2014 Life Tables

CMS will begin referencing the CDC’s Table 1: Life Table for the total population: United States, 2014, for WCMSA life expectancy calculations on December 11, 2017. A link to the CDC’s 2014 Life Tables can be found in the Related Links section at the bottom of the page.

October 24, 2017 – Consideration for Expansion of Medicare Set-Aside Arrangements (MSA)

The Centers for Medicare and Medicaid Services (CMS) continues to consider expanding its voluntary Medicare Set-Aside Arrangements (MSA) review process to include liability insurance (including self-insurance) and no-fault insurance MSA amounts. CMS will work closely with the stakeholder community to identify how best to implement this potential expansion of voluntary MSA reviews. Please continue to monitor this website for updates and announcements of town hall meetings in the near future.

July 31, 2017 – Revised Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide

Version 2.6 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide is now available in the Download section of the Workers’ Compensation Medicare Set Aside Arrangements page.  In addition to providing clarifications to existing policies, CMS has expanded the criteria for submission of a WCMSA re-review. Effective 07/31/2017, submitters can submit a re-review request where CMS has provided an approved amount, but settlement has not occurred and the medical care that supported the approved amount has changed substantially. The clarifications also address situations where certain states rely on Utilization Review processes to justify proposed WCMSA amounts.  Please refer to the revised WCMSA Reference Guide for more details.

March 8, 2017 - Use of the Center for Disease Control (CDC) 2012 Life Tables

CMS will begin referencing the CDC’s Table 1: Life Table for the total population: United States, 2012, for WCMSA life expectancy calculations on April 1, 2017. A link to the CDC’s 2012 Life Tables may be found in the Related Links section near the bottom of the page.

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