New WCMSA Self-Admin Tool Kit – CMS updates on MAP and Part D plans

The Centers for Medicare and Medicaid Services (CMS) has released an updated Workers' Compensation Medicare Set-Aside (WCMSA) Self-Administration Tool Kit (Version 1.6, August 1, 2024).

While CMS did not include a "Summary of Changes" section as part of this revised resource, from the authors' review, it appears that the main updates concern, in part, added verbiage and instructions regarding Medicare Part C - Medicare Advantage Plans (MAPs) and Medicare Part D (Prescription Drug Plans).

For example, CMS, in part, added the following verbiage and instructions to Section 4 (Using the Account) regarding MAPs and Part D:

"CMS will tell your Medicare Advantage or prescription drug plan that a WCMSA has been approved. Insurance plans are not given specific information about treatment and medications that should be covered by the WCMSA. You must tell your insurance plan sponsor any details concerning treatments and medications used exclusively to treat a related illness or injury, so they can avoid making primary payment in the future. CMS requires your plan to contact you or the administrator of your WCMSA to find out which expenses are covered by your WCMSA. The plan must avoid paying for expenses that are included in the WCMSA. The plan has a responsibility to recover any payments it made that should have been paid by the WCMSA. If you do not respond to your plan's investigation efforts, your coverage may be delayed or cancelled. If you are enrolled in a Medicare Advantage or prescription drug plan, please contact your plan to discuss your WCMSA, if you have not already done so." Workers' Compensation Medicare Set-Aside (WCMSA) Self-Administration Tool Kit (Version 1.6, August 1, 2024), Section 4.

In addition, CMS added the following instructions for claimants regarding their annual attestation requirement as addressed in Section 8 (Annual Attestation): "This attestation is required annually, even if you are enrolled in a Medicare Advantage or prescription drug plan. You should also contact your plan to discuss any changes in medication or treatment that should be covered by the WCMSA." Workers' Compensation Medicare Set-Aside (WCMSA) Self-Administration Tool Kit (Version 1.6, August 1, 2024), Section 8.

In the big picture, CMS's updates regarding MAPs and Part D plans above coincide with other updates CMS made to its WCMSA Reference Guide which also include, in main part, added verbiage regarding MAPs and Part D plans with respect to WCMSA arrangements.

Please contact the authors if you have any questions regarding the above, or other Medicare secondary payer compliance issues.