** Alert December 19, 2008 ** In an effort to share more information with the workers' compensation industry and workers' compensation Medicare set-aside arrangement submitters, and to reduce the instance of incomplete set-aside proposals, CMS is posting the "Operating Rules" used by its workers' compensation review contractor and will provide periodic updates when there are changes to these operating rules.

** Alert December 5, 2008 ** For Cases with Rated Ages!

Cases that close for insufficient information, withdrawal, or some other reason will automatically reopen when new information is received. Such cases are considered new WCMSA submissions as of the date the new information is received. (See CMS Memorandum dated July 24, 2006, Question and Answer 4.) Submitters should be aware that the new rules announced in the CMS August 25, 2008 memorandum – including the requirement for a statement that all rated ages obtained on the claimant have been included – will apply to cases reopened October 1, 2008 or later. Therefore, submitters of cases with rated ages may wish to consider including the required statement, where applicable, in all correspondence sent in response to CMS development requests, to avoid an unintended application of the new rated age rules and the use of actual age in cases closed before the development reply was received.

August 25, 2008 Policy Memorandum.

The above policy memorandum may be found under "WCMSA – Related Topics" link located on the left. Due to technical difficulties in posting the notice, the implementation date for pricing of Implantable Devices, and furnishing acceptable proof and a statement from the submitter that all rated ages obtained have been included is extended to October 1, 2008. The rescission of question and answer 10 of the July 11, 2005 memorandum remains effective immediately. Future policy memorandums will be posted to the "WCMSA – Related Topics" link.

The most current CDC Life Expectancy Table (Table 1, total population may be found by coping and pasting the address below into your URL Address browser:   

http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf

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

Please note that you may see references throughout this section such as "(Ref:  ________Memo Q_)", which indicate the following sources for the stated policies:

• July 23, 2001 letter, "Workers' Compensation: Commutation of Future Benefits"
• April 21, 2003 letter "Medicare Secondary Payer - Workers' Compensation (WC) Frequently Asked Questions." Medicare Secondary Payer Regional Office WC contacts are listed in an attachment to this letter. The WC contacts can provide a detailed list of documents necessary to complete a review of a settlement that includes a Medicare set-aside arrangement for future medical benefits.
• May 23, 2003 letter "Medicare Secondary Payer - Workers' Compensation (WC) Additional Frequently Asked Questions"
• On May 7, 2004, CMS issued a Memorandum discussing its new policy regarding the use of administrative fees in WC cases.
• On October 15, 2004, CMS issued a Memorandum discussing new and updated Workers' Compensation (WC) Frequently Asked Questions.
• On July 11, 2005, CMS issued a Memorandum discussing new and updated Workers' Compensation (WC) Frequently Asked Questions.
• On December 30, 2005, CMS issued a Memorandum discussing Part D and Workers' Compensation Medicare Set-aside Arrangements (WCMSAs) Questions and Answers--Superseded by the July 24, 2006 memorandum

• On April 25, 2006, CMS issued a Memorandum discussing the Workers' Compensation Medicare Set-Aside Arrangements (WCMSAs) and the revision of the low dollar threshold for Medicare beneficiaries

• On July 24, 2006 CMS issued a memorandum discussing Part D and Workers' Compensation Medicare Set-aside Arrangements (WCMSAs) Questions and Answers.

These sources, or policy memoranda, were developed by CMS and were available on the prior web site. Links to the original documents can be found below under Downloads.

Downloads
July 23, 2001 Memorandum (PDF, 83 KB) April 21, 2003 Memorandum (PDF, 935 KB) May 23, 2003 Memorandum (PDF, 190 KB) May 7, 2004 Memorandum (PDF, 9KB) October 15, 2004 Memorandum (PDF, 192 KB) December 30, 2005 Memorandum (PDF, 184 KB) July 11, 2005 Memorandum (PDF, 137 KB) April 25, 2006 Memorandum (PDF, 135KB) July 24, 2006 Memorandum (PDF, 184 KB) May 20, 2008 Memorandum (PDF, 54 KB)
Related Links Inside CMS
Subscription Sign-up for Workers' Compensation Web Page Update Notification
Related Links Outside CMS
There are no Related Links Outside CMS

Page Last Modified: 12/19/2008 11:40:44 AM
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